|
BUSPIRONE 7.5 MG TABLET [29967]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 16729-201-01
|
| Hospital Charge Code |
ERX29967
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Distinction Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
BUSPIRONE 7.5 MG TABLET [29967]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
NDC 16729-201-01
|
| Hospital Charge Code |
ERX29967
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
BUSPIRONE 7.5 MG TABLET [29967]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 68382-623-01
|
| Hospital Charge Code |
ERX29967
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Distinction Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
BUSPIRONE 7.5 MG TABLET [29967]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 64380-787-06
|
| Hospital Charge Code |
ERX29967
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Distinction Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 70010-044-01
|
| Hospital Charge Code |
ERX104993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.85
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 70010-044-01
|
| Hospital Charge Code |
ERX104993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Distinction Transplant |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Media |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.85
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 42195-955-10
|
| Hospital Charge Code |
ERX104993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 42195-955-10
|
| Hospital Charge Code |
ERX104993
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Blue Distinction Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Media |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE [8922]
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
NDC 0591-3219-01
|
| Hospital Charge Code |
1730054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Blue Distinction Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: Dignity Health Media |
$1.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE [8922]
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
NDC 0591-3219-01
|
| Hospital Charge Code |
1730054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
BUTORPHANOL 10 MG/ML NASAL SPRAY [9335]
|
Facility
|
OP
|
$27.07
|
|
|
Service Code
|
NDC 60505-0813-1
|
| Hospital Charge Code |
1740276
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.13
|
| Rate for Payer: Blue Distinction Transplant |
$16.24
|
| Rate for Payer: Blue Shield of California Commercial |
$19.95
|
| Rate for Payer: Blue Shield of California EPN |
$15.81
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cigna of CA HMO |
$18.95
|
| Rate for Payer: Cigna of CA PPO |
$18.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.01
|
| Rate for Payer: Dignity Health Media |
$23.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.83
|
| Rate for Payer: Galaxy Health WC |
$23.01
|
| Rate for Payer: Global Benefits Group Commercial |
$16.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Multiplan Commercial |
$21.66
|
| Rate for Payer: Networks By Design Commercial |
$17.60
|
| Rate for Payer: Prime Health Services Commercial |
$23.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.01
|
| Rate for Payer: Vantage Medical Group Senior |
$23.01
|
|
|
BUTORPHANOL 10 MG/ML NASAL SPRAY [9335]
|
Facility
|
IP
|
$27.07
|
|
|
Service Code
|
NDC 60505-0813-1
|
| Hospital Charge Code |
1740276
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Blue Shield of California Commercial |
$19.27
|
| Rate for Payer: Blue Shield of California EPN |
$13.86
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cigna of CA HMO |
$18.95
|
| Rate for Payer: Cigna of CA PPO |
$18.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.83
|
| Rate for Payer: Galaxy Health WC |
$23.01
|
| Rate for Payer: Global Benefits Group Commercial |
$16.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Multiplan Commercial |
$21.66
|
| Rate for Payer: Networks By Design Commercial |
$17.60
|
| Rate for Payer: Prime Health Services Commercial |
$23.01
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION [9333]
|
Facility
|
OP
|
$7.36
|
|
|
Service Code
|
CPT J0595
|
| Hospital Charge Code |
1720353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.02
|
| Rate for Payer: Blue Distinction Transplant |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cigna of CA HMO |
$5.15
|
| Rate for Payer: Cigna of CA PPO |
$5.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.26
|
| Rate for Payer: Dignity Health Media |
$6.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$6.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.89
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: Vantage Medical Group Senior |
$6.26
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION [9333]
|
Facility
|
IP
|
$7.36
|
|
|
Service Code
|
CPT J0595
|
| Hospital Charge Code |
1720353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Blue Shield of California Commercial |
$5.24
|
| Rate for Payer: Blue Shield of California EPN |
$3.77
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cigna of CA HMO |
$5.15
|
| Rate for Payer: Cigna of CA PPO |
$5.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$6.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.89
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2.71
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
CPT J0595
|
| Hospital Charge Code |
1720351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.02
|
| Rate for Payer: Blue Distinction Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
CPT J0595
|
| Hospital Charge Code |
1720351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
|
OP
|
$6.34
|
|
|
Service Code
|
CPT J0595
|
| Hospital Charge Code |
1720575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.02
|
| Rate for Payer: Blue Distinction Transplant |
$3.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cigna of CA HMO |
$4.44
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.39
|
| Rate for Payer: Dignity Health Media |
$5.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.39
|
| Rate for Payer: Global Benefits Group Commercial |
$3.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.07
|
| Rate for Payer: Networks By Design Commercial |
$3.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.39
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
|
IP
|
$6.34
|
|
|
Service Code
|
CPT J0595
|
| Hospital Charge Code |
1720575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Blue Shield of California Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cigna of CA HMO |
$4.44
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.39
|
| Rate for Payer: Global Benefits Group Commercial |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.07
|
| Rate for Payer: Networks By Design Commercial |
$3.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.09
|
|
|
BUTT PASTE OINT (LLUMC) [4080617]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 9994-0806-17
|
| Hospital Charge Code |
1743709
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.94
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California EPN |
$8.76
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Media |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
BUTT PASTE OINT (LLUMC) [4080617]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 9994-0806-17
|
| Hospital Charge Code |
1743709
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Blue Shield of California Commercial |
$10.68
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT [192162]
|
Facility
|
IP
|
$4,344.83
|
|
|
Service Code
|
CPT J0597
|
| Hospital Charge Code |
ERX192145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,042.76 |
| Max. Negotiated Rate |
$3,693.11 |
| Rate for Payer: Blue Shield of California Commercial |
$3,093.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,224.55
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cigna of CA HMO |
$3,041.38
|
| Rate for Payer: Cigna of CA PPO |
$3,041.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,737.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,737.93
|
| Rate for Payer: Galaxy Health WC |
$3,693.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2,606.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,898.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,655.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.76
|
| Rate for Payer: Multiplan Commercial |
$3,475.86
|
| Rate for Payer: Networks By Design Commercial |
$2,172.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,693.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,640.61
|
| Rate for Payer: United Healthcare All Other HMO |
$1,602.37
|
| Rate for Payer: United Healthcare HMO Rider |
$1,567.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,433.79
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT [192162]
|
Facility
|
OP
|
$4,344.83
|
|
|
Service Code
|
CPT J0597
|
| Hospital Charge Code |
ERX192145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.36 |
| Max. Negotiated Rate |
$3,693.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$404.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.50
|
| Rate for Payer: Blue Distinction Transplant |
$2,606.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,202.14
|
| Rate for Payer: Blue Shield of California EPN |
$74.40
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cigna of CA HMO |
$3,041.38
|
| Rate for Payer: Cigna of CA PPO |
$3,041.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.53
|
| Rate for Payer: Dignity Health Media |
$64.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$64.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.36
|
| Rate for Payer: Galaxy Health WC |
$3,693.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2,606.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,258.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$105.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$104.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,898.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.24
|
| Rate for Payer: Multiplan Commercial |
$3,475.86
|
| Rate for Payer: Networks By Design Commercial |
$2,172.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,693.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,606.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,606.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,172.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,172.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,172.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.79
|
| Rate for Payer: Vantage Medical Group Senior |
$64.36
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION [196347]
|
Facility
|
IP
|
$4,344.83
|
|
|
Service Code
|
CPT J0597
|
| Hospital Charge Code |
ERX196347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,042.76 |
| Max. Negotiated Rate |
$3,693.11 |
| Rate for Payer: Blue Shield of California Commercial |
$3,093.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,224.55
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cigna of CA HMO |
$3,041.38
|
| Rate for Payer: Cigna of CA PPO |
$3,041.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,737.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,737.93
|
| Rate for Payer: Galaxy Health WC |
$3,693.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2,606.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,898.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,655.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.76
|
| Rate for Payer: Multiplan Commercial |
$3,475.86
|
| Rate for Payer: Networks By Design Commercial |
$2,172.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,693.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,640.61
|
| Rate for Payer: United Healthcare All Other HMO |
$1,602.37
|
| Rate for Payer: United Healthcare HMO Rider |
$1,567.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,433.79
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION [196347]
|
Facility
|
OP
|
$4,344.83
|
|
|
Service Code
|
CPT J0597
|
| Hospital Charge Code |
ERX196347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.36 |
| Max. Negotiated Rate |
$3,693.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$404.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.50
|
| Rate for Payer: Blue Distinction Transplant |
$2,606.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,202.14
|
| Rate for Payer: Blue Shield of California EPN |
$74.40
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cigna of CA HMO |
$3,041.38
|
| Rate for Payer: Cigna of CA PPO |
$3,041.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.53
|
| Rate for Payer: Dignity Health Media |
$64.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$64.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.36
|
| Rate for Payer: Galaxy Health WC |
$3,693.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2,606.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,258.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$105.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$104.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,898.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.24
|
| Rate for Payer: Multiplan Commercial |
$3,475.86
|
| Rate for Payer: Networks By Design Commercial |
$2,172.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,693.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,606.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,606.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,172.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,172.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,172.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.79
|
| Rate for Payer: Vantage Medical Group Senior |
$64.36
|
|
|
C1 ESTERASE INHIBITOR, RECOMBINANT 2,100 UNIT INTRAVENOUS SOLUTION [207371]
|
Facility
|
OP
|
$8,724.00
|
|
|
Service Code
|
CPT J0596
|
| Hospital Charge Code |
ERX207371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.51 |
| Max. Negotiated Rate |
$7,415.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$210.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.40
|
| Rate for Payer: Blue Distinction Transplant |
$5,234.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,429.59
|
| Rate for Payer: Blue Shield of California EPN |
$35.62
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Cigna of CA HMO |
$6,106.80
|
| Rate for Payer: Cigna of CA PPO |
$6,106.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.26
|
| Rate for Payer: Dignity Health Media |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.51
|
| Rate for Payer: Galaxy Health WC |
$7,415.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,234.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,543.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$54.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$54.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,818.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,093.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.90
|
| Rate for Payer: Multiplan Commercial |
$6,979.20
|
| Rate for Payer: Networks By Design Commercial |
$4,362.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,415.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,234.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,234.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,362.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,362.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,362.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,362.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.86
|
| Rate for Payer: Vantage Medical Group Senior |
$33.51
|
|
