|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107661]
|
Facility
OP
|
$95.32
|
|
|
Service Code
|
NDC 0093-3657-40
|
| Hospital Charge Code |
ERX107661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.79
|
| Rate for Payer: BCBS Transplant Transplant |
$57.19
|
| Rate for Payer: Blue Shield of California Commercial |
$70.25
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$42.89
|
| Rate for Payer: Cigna of CA HMO |
$66.72
|
| Rate for Payer: Cigna of CA PPO |
$66.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.02
|
| Rate for Payer: Dignity Health Media |
$81.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.13
|
| Rate for Payer: Galaxy Health WC |
$81.02
|
| Rate for Payer: Global Benefits Group Commercial |
$57.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$71.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.88
|
| Rate for Payer: Multiplan Commercial |
$76.26
|
| Rate for Payer: Networks By Design Commercial |
$61.96
|
| Rate for Payer: Prime Health Services Commercial |
$81.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$57.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.66
|
| Rate for Payer: United Healthcare All Other HMO |
$47.66
|
| Rate for Payer: United Healthcare HMO Rider |
$47.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.02
|
| Rate for Payer: Vantage Medical Group Senior |
$81.02
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107661]
|
Facility
IP
|
$95.32
|
|
|
Service Code
|
NDC 0093-3657-40
|
| Hospital Charge Code |
ERX107661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Blue Shield of California Commercial |
$67.87
|
| Rate for Payer: Blue Shield of California EPN |
$48.80
|
| Rate for Payer: Cash Price |
$42.89
|
| Rate for Payer: Cigna of CA HMO |
$66.72
|
| Rate for Payer: Cigna of CA PPO |
$66.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.13
|
| Rate for Payer: Galaxy Health WC |
$81.02
|
| Rate for Payer: Global Benefits Group Commercial |
$57.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.88
|
| Rate for Payer: Multiplan Commercial |
$76.26
|
| Rate for Payer: Networks By Design Commercial |
$61.96
|
| Rate for Payer: Prime Health Services Commercial |
$81.02
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107661]
|
Facility
IP
|
$95.32
|
|
|
Service Code
|
NDC 0093-3657-21
|
| Hospital Charge Code |
ERX107661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Blue Shield of California Commercial |
$67.87
|
| Rate for Payer: Blue Shield of California EPN |
$48.80
|
| Rate for Payer: Cash Price |
$42.89
|
| Rate for Payer: Cigna of CA HMO |
$66.72
|
| Rate for Payer: Cigna of CA PPO |
$66.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.13
|
| Rate for Payer: Galaxy Health WC |
$81.02
|
| Rate for Payer: Global Benefits Group Commercial |
$57.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.88
|
| Rate for Payer: Multiplan Commercial |
$76.26
|
| Rate for Payer: Networks By Design Commercial |
$61.96
|
| Rate for Payer: Prime Health Services Commercial |
$81.02
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107661]
|
Facility
OP
|
$95.32
|
|
|
Service Code
|
NDC 0093-3657-21
|
| Hospital Charge Code |
ERX107661
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.79
|
| Rate for Payer: BCBS Transplant Transplant |
$57.19
|
| Rate for Payer: Blue Shield of California Commercial |
$70.25
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$42.89
|
| Rate for Payer: Cigna of CA HMO |
$66.72
|
| Rate for Payer: Cigna of CA PPO |
$66.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.02
|
| Rate for Payer: Dignity Health Media |
$81.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.13
|
| Rate for Payer: Galaxy Health WC |
$81.02
|
| Rate for Payer: Global Benefits Group Commercial |
$57.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$71.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.88
|
| Rate for Payer: Multiplan Commercial |
$76.26
|
| Rate for Payer: Networks By Design Commercial |
$61.96
|
| Rate for Payer: Prime Health Services Commercial |
$81.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$57.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.66
|
| Rate for Payer: United Healthcare All Other HMO |
$47.66
|
| Rate for Payer: United Healthcare HMO Rider |
$47.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.02
|
| Rate for Payer: Vantage Medical Group Senior |
$81.02
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM [106176]
|
Facility
IP
|
$4.24
|
|
|
Service Code
|
CPT J0572
|
| Hospital Charge Code |
ERX106176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Blue Shield of California Commercial |
$3.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna of CA HMO |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$2.97
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Cigna of CA PPO |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$2.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$3.39
|
| Rate for Payer: Networks By Design Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$2.12
|
| Rate for Payer: Prime Health Services Commercial |
$2.27
|
| Rate for Payer: Prime Health Services Commercial |
$3.60
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM [106176]
|
Facility
OP
|
$2.67
|
|
|
Service Code
|
CPT J0572
|
| Hospital Charge Code |
ERX106176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$24.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: BCBS Transplant Transplant |
$1.60
|
| Rate for Payer: BCBS Transplant Transplant |
$2.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna of CA HMO |
$2.97
|
| Rate for Payer: Cigna of CA HMO |
$1.87
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Cigna of CA PPO |
$1.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.60
|
| Rate for Payer: Dignity Health Media |
$3.60
|
| Rate for Payer: Dignity Health Media |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$2.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$3.39
|
| Rate for Payer: Networks By Design Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$2.12
|
| Rate for Payer: Prime Health Services Commercial |
$2.27
|
| Rate for Payer: Prime Health Services Commercial |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.60
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET [34713]
|
Facility
IP
|
$1.33
|
|
|
Service Code
|
CPT J0572
|
| Hospital Charge Code |
1734058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET [34713]
|
Facility
OP
|
$1.11
|
|
|
Service Code
|
CPT J0572
|
| Hospital Charge Code |
1734058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$24.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.13
|
| 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 Medi-Cal |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: BCBS Transplant Transplant |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Media |
$1.13
|
| Rate for Payer: Dignity Health Media |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.13
|
| 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 Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107660]
|
Facility
OP
|
$64.43
|
|
|
Service Code
|
NDC 42858-750-40
|
| Hospital Charge Code |
ERX107660
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.46 |
| Max. Negotiated Rate |
$54.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$54.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.39
|
| Rate for Payer: BCBS Transplant Transplant |
$38.66
|
| Rate for Payer: Blue Shield of California Commercial |
$47.48
|
| Rate for Payer: Blue Shield of California EPN |
$37.63
|
| Rate for Payer: Cash Price |
$28.99
|
| Rate for Payer: Cigna of CA HMO |
$45.10
|
| Rate for Payer: Cigna of CA PPO |
$45.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.77
|
| Rate for Payer: Dignity Health Media |
$54.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.77
|
| Rate for Payer: Galaxy Health WC |
$54.77
|
| Rate for Payer: Global Benefits Group Commercial |
$38.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.46
|
| Rate for Payer: Multiplan Commercial |
$51.54
|
| Rate for Payer: Networks By Design Commercial |
$41.88
|
| Rate for Payer: Prime Health Services Commercial |
$54.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$38.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.22
|
| Rate for Payer: United Healthcare All Other HMO |
$32.22
|
| Rate for Payer: United Healthcare HMO Rider |
$32.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.77
|
| Rate for Payer: Vantage Medical Group Senior |
$54.77
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH [107660]
|
Facility
IP
|
$64.43
|
|
|
Service Code
|
NDC 42858-750-40
|
| Hospital Charge Code |
ERX107660
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.46 |
| Max. Negotiated Rate |
$54.77 |
| Rate for Payer: Blue Shield of California Commercial |
$45.87
|
| Rate for Payer: Blue Shield of California EPN |
$32.99
|
| Rate for Payer: Cash Price |
$28.99
|
| Rate for Payer: Cigna of CA HMO |
$45.10
|
| Rate for Payer: Cigna of CA PPO |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.77
|
| Rate for Payer: Galaxy Health WC |
$54.77
|
| Rate for Payer: Global Benefits Group Commercial |
$38.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.46
|
| Rate for Payer: Multiplan Commercial |
$51.54
|
| Rate for Payer: Networks By Design Commercial |
$41.88
|
| Rate for Payer: Prime Health Services Commercial |
$54.77
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET [34714]
|
Facility
OP
|
$4.78
|
|
|
Service Code
|
CPT J0574
|
| Hospital Charge Code |
ERX34714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$48.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.06
|
| Rate for Payer: BCBS Transplant Transplant |
$2.87
|
| Rate for Payer: BCBS Transplant Transplant |
$2.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$8.60
|
| Rate for Payer: Blue Shield of California EPN |
$8.60
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna of CA HMO |
$3.35
|
| Rate for Payer: Cigna of CA HMO |
$2.86
|
| Rate for Payer: Cigna of CA PPO |
$3.35
|
| Rate for Payer: Cigna of CA PPO |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.06
|
| Rate for Payer: Dignity Health Media |
$4.06
|
| Rate for Payer: Dignity Health Media |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.91
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$4.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO |
$2.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.06
|
| Rate for Payer: Vantage Medical Group Senior |
$4.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET [34714]
|
Facility
IP
|
$4.09
|
|
|
Service Code
|
CPT J0574
|
| Hospital Charge Code |
ERX34714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Blue Shield of California Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$3.35
|
| Rate for Payer: Cigna of CA PPO |
$2.86
|
| Rate for Payer: Cigna of CA PPO |
$3.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.91
|
| Rate for Payer: Galaxy Health WC |
$4.06
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$3.27
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION [117588]
|
Facility
IP
|
$16.34
|
|
|
Service Code
|
CPT J0592
|
| Hospital Charge Code |
NDG117588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$13.89 |
| Rate for Payer: Blue Shield of California Commercial |
$11.63
|
| Rate for Payer: Blue Shield of California EPN |
$8.37
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Cigna of CA HMO |
$11.44
|
| Rate for Payer: Cigna of CA PPO |
$11.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.54
|
| Rate for Payer: Galaxy Health WC |
$13.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$13.07
|
| Rate for Payer: Networks By Design Commercial |
$8.17
|
| Rate for Payer: Prime Health Services Commercial |
$13.89
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION [117588]
|
Facility
OP
|
$16.34
|
|
|
Service Code
|
CPT J0592
|
| Hospital Charge Code |
NDG117588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: BCBS Transplant Transplant |
$9.80
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.43
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Cigna of CA HMO |
$11.44
|
| Rate for Payer: Cigna of CA PPO |
$11.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.89
|
| Rate for Payer: Dignity Health Media |
$13.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.54
|
| Rate for Payer: Galaxy Health WC |
$13.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$13.07
|
| Rate for Payer: Networks By Design Commercial |
$8.17
|
| Rate for Payer: Prime Health Services Commercial |
$13.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.17
|
| Rate for Payer: United Healthcare All Other HMO |
$8.17
|
| Rate for Payer: United Healthcare HMO Rider |
$8.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.89
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET [34711]
|
Facility
IP
|
$0.37
|
|
|
Service Code
|
CPT J0571
|
| Hospital Charge Code |
ERX34711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET [34711]
|
Facility
OP
|
$0.37
|
|
|
Service Code
|
CPT J0571
|
| Hospital Charge Code |
ERX34711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Media |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET [34712]
|
Facility
IP
|
$4.20
|
|
|
Service Code
|
CPT J0571
|
| Hospital Charge Code |
ERX34712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET [34712]
|
Facility
OP
|
$4.20
|
|
|
Service Code
|
CPT J0571
|
| Hospital Charge Code |
ERX34712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
| Rate for Payer: BCBS Transplant Transplant |
$2.52
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Media |
$1.70
|
| Rate for Payer: Dignity Health Media |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
BUPROPION HCL 100 MG TABLET [9321]
|
Facility
IP
|
$0.86
|
|
|
Service Code
|
NDC 60505-0157-1
|
| Hospital Charge Code |
1711391
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.73
|
|
|
BUPROPION HCL 100 MG TABLET [9321]
|
Facility
OP
|
$0.80
|
|
|
Service Code
|
NDC 68001-309-00
|
| Hospital Charge Code |
1711391
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: BCBS Transplant Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Media |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
BUPROPION HCL 100 MG TABLET [9321]
|
Facility
OP
|
$2.12
|
|
|
Service Code
|
NDC 50268-143-15
|
| Hospital Charge Code |
1711391
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.26
|
| Rate for Payer: BCBS Transplant Transplant |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Media |
$1.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1.80
|
|
|
BUPROPION HCL 100 MG TABLET [9321]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 23155-192-01
|
| Hospital Charge Code |
1711391
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
BUPROPION HCL 100 MG TABLET [9321]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
NDC 23155-192-01
|
| Hospital Charge Code |
1711391
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
BUPROPION HCL 100 MG TABLET [9321]
|
Facility
OP
|
$0.86
|
|
|
Service Code
|
NDC 60505-0157-1
|
| Hospital Charge Code |
1711391
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Galaxy Health WC |
$0.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.51
|
| Rate for Payer: BCBS Transplant Transplant |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Media |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.73
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.73
|
|
|
BUPROPION HCL 100 MG TABLET [9321]
|
Facility
IP
|
$2.12
|
|
|
Service Code
|
NDC 50268-143-15
|
| Hospital Charge Code |
1711391
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
|
