|
MEPIVACAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [4081086]
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
CPT J0670
|
| Hospital Charge Code |
NDC4081086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
|
|
MEPIVACAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [4081086]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
CPT J0670
|
| Hospital Charge Code |
NDC4081086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.70
|
| Rate for Payer: Blue Distinction Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]
|
Facility
|
IP
|
$4,033.58
|
|
|
Service Code
|
CPT J2182
|
| Hospital Charge Code |
ERX211796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$968.06 |
| Max. Negotiated Rate |
$3,428.54 |
| Rate for Payer: Blue Shield of California Commercial |
$2,871.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,065.19
|
| Rate for Payer: Cash Price |
$1,815.11
|
| Rate for Payer: Cigna of CA HMO |
$2,823.51
|
| Rate for Payer: Cigna of CA PPO |
$2,823.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,613.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,613.43
|
| Rate for Payer: Galaxy Health WC |
$3,428.54
|
| Rate for Payer: Global Benefits Group Commercial |
$2,420.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,690.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,536.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.06
|
| Rate for Payer: Multiplan Commercial |
$3,226.86
|
| Rate for Payer: Networks By Design Commercial |
$2,016.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,428.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,523.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1,487.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,455.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,331.08
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]
|
Facility
|
OP
|
$4,033.58
|
|
|
Service Code
|
CPT J2182
|
| Hospital Charge Code |
ERX211796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$3,428.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$191.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.85
|
| Rate for Payer: Blue Distinction Transplant |
$2,420.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,972.75
|
| Rate for Payer: Blue Shield of California EPN |
$36.89
|
| Rate for Payer: Cash Price |
$1,815.11
|
| Rate for Payer: Cash Price |
$1,815.11
|
| Rate for Payer: Cigna of CA HMO |
$2,823.51
|
| Rate for Payer: Cigna of CA PPO |
$2,823.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.76
|
| Rate for Payer: Dignity Health Media |
$30.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.50
|
| Rate for Payer: Galaxy Health WC |
$3,428.54
|
| Rate for Payer: Global Benefits Group Commercial |
$2,420.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,025.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$50.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$49.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,690.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.88
|
| Rate for Payer: Multiplan Commercial |
$3,226.86
|
| Rate for Payer: Networks By Design Commercial |
$2,016.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,428.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,420.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,420.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,016.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2,016.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2,016.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,016.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.56
|
| Rate for Payer: Vantage Medical Group Senior |
$30.50
|
|
|
MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [206120]
|
Facility
|
IP
|
$17.20
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
NDG206120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Blue Shield of California Commercial |
$12.25
|
| Rate for Payer: Blue Shield of California EPN |
$8.81
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cigna of CA HMO |
$12.04
|
| Rate for Payer: Cigna of CA PPO |
$12.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.88
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$8.60
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.49
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$6.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
|
|
MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [206120]
|
Facility
|
OP
|
$17.20
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
NDG206120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.08
|
| Rate for Payer: Blue Distinction Transplant |
$10.32
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cigna of CA HMO |
$12.04
|
| Rate for Payer: Cigna of CA PPO |
$12.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.62
|
| Rate for Payer: Dignity Health Media |
$14.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.88
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$8.60
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.60
|
| Rate for Payer: United Healthcare All Other HMO |
$8.60
|
| Rate for Payer: United Healthcare HMO Rider |
$8.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.62
|
| Rate for Payer: Vantage Medical Group Senior |
$14.62
|
|
|
MERCAPTOPURINE 25 MG 1/2 TAB [192268]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1712421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| 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 Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
|
|
MERCAPTOPURINE 25 MG 1/2 TAB [192268]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1712421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.08
|
| Rate for Payer: Blue Distinction Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Media |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| 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: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| 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 Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
MERCAPTOPURINE 50 MG TABLET [10531]
|
Facility
|
OP
|
$3.80
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1711074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.08
|
| Rate for Payer: Blue Distinction Transplant |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.23
|
| Rate for Payer: Dignity Health Media |
$3.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Networks By Design Commercial |
$2.47
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.23
|
| Rate for Payer: Vantage Medical Group Senior |
$3.23
|
|
|
MERCAPTOPURINE 50 MG TABLET [10531]
|
Facility
|
IP
|
$3.80
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1711074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Networks By Design Commercial |
$2.47
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]
|
Facility
|
IP
|
$22.01
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
ERX17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Blue Shield of California Commercial |
$25.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4.91
|
| Rate for Payer: Blue Shield of California Commercial |
$17.09
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California EPN |
$12.29
|
| Rate for Payer: Blue Shield of California EPN |
$12.72
|
| Rate for Payer: Blue Shield of California EPN |
$11.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.53
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$17.40
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$15.41
|
| Rate for Payer: Cigna of CA PPO |
$4.83
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$17.40
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$15.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.94
|
| Rate for Payer: Galaxy Health WC |
$5.86
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Galaxy Health WC |
$18.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.14
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$19.88
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$17.61
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$3.45
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
| Rate for Payer: Prime Health Services Commercial |
$18.71
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$5.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.06
|
| Rate for Payer: United Healthcare All Other HMO |
$8.85
|
| Rate for Payer: United Healthcare All Other HMO |
$8.12
|
| Rate for Payer: United Healthcare All Other HMO |
$9.16
|
| Rate for Payer: United Healthcare All Other HMO |
$13.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.49
|
| Rate for Payer: United Healthcare HMO Rider |
$12.99
|
| Rate for Payer: United Healthcare HMO Rider |
$8.66
|
| Rate for Payer: United Healthcare HMO Rider |
$7.94
|
| Rate for Payer: United Healthcare HMO Rider |
$8.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.20
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]
|
Facility
|
OP
|
$24.85
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
ERX17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Distinction Transplant |
$13.21
|
| Rate for Payer: Blue Distinction Transplant |
$14.91
|
| Rate for Payer: Blue Distinction Transplant |
$14.40
|
| Rate for Payer: Blue Distinction Transplant |
$4.14
|
| Rate for Payer: Blue Shield of California Commercial |
$16.22
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$18.31
|
| Rate for Payer: Blue Shield of California Commercial |
$26.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$15.41
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$17.40
|
| Rate for Payer: Cigna of CA PPO |
$17.40
|
| Rate for Payer: Cigna of CA PPO |
$4.83
|
| Rate for Payer: Cigna of CA PPO |
$15.41
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.12
|
| Rate for Payer: Dignity Health Media |
$18.71
|
| Rate for Payer: Dignity Health Media |
$20.40
|
| Rate for Payer: Dignity Health Media |
$30.60
|
| Rate for Payer: Dignity Health Media |
$21.12
|
| Rate for Payer: Dignity Health Media |
$5.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Galaxy Health WC |
$18.71
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$5.86
|
| Rate for Payer: Global Benefits Group Commercial |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Global Benefits Group Commercial |
$4.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$19.88
|
| Rate for Payer: Multiplan Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$17.61
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$3.45
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$18.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.42
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.45
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.45
|
| Rate for Payer: United Healthcare HMO Rider |
$11.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$18.71
|
| Rate for Payer: Vantage Medical Group Senior |
$5.86
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$21.12
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
1753510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Blue Distinction Transplant |
$7.42
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California Commercial |
$8.11
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$8.65
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$8.65
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Media |
$9.35
|
| Rate for Payer: Dignity Health Media |
$10.20
|
| Rate for Payer: Dignity Health Media |
$10.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.94
|
| Rate for Payer: Galaxy Health WC |
$10.51
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7.42
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Networks By Design Commercial |
$5.50
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Prime Health Services Commercial |
$10.51
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.18
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.18
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.51
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
1753510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$8.80
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Blue Shield of California EPN |
$6.33
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cigna of CA HMO |
$8.65
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Galaxy Health WC |
$10.51
|
| Rate for Payer: Global Benefits Group Commercial |
$7.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$9.89
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.50
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$10.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Other HMO |
$4.43
|
| Rate for Payer: United Healthcare All Other HMO |
$4.06
|
| Rate for Payer: United Healthcare All Other HMO |
$4.56
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$4.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.08
|
|
|
MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]
|
Facility
|
IP
|
$259.20
|
|
|
Service Code
|
CPT J2186
|
| Hospital Charge Code |
ERX219863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Blue Shield of California Commercial |
$184.55
|
| Rate for Payer: Blue Shield of California EPN |
$132.71
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cigna of CA HMO |
$181.44
|
| Rate for Payer: Cigna of CA PPO |
$181.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$103.68
|
| Rate for Payer: Galaxy Health WC |
$220.32
|
| Rate for Payer: Global Benefits Group Commercial |
$155.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.21
|
| Rate for Payer: Multiplan Commercial |
$207.36
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$220.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.87
|
| Rate for Payer: United Healthcare All Other HMO |
$95.59
|
| Rate for Payer: United Healthcare HMO Rider |
$93.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.54
|
|
|
MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]
|
Facility
|
OP
|
$259.20
|
|
|
Service Code
|
CPT J2186
|
| Hospital Charge Code |
ERX219863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.45
|
| Rate for Payer: Blue Distinction Transplant |
$155.52
|
| Rate for Payer: Blue Shield of California Commercial |
$191.03
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cigna of CA HMO |
$181.44
|
| Rate for Payer: Cigna of CA PPO |
$181.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.11
|
| Rate for Payer: Dignity Health Media |
$2.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$220.32
|
| Rate for Payer: Global Benefits Group Commercial |
$155.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$194.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$207.36
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$220.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Other HMO |
$129.60
|
| Rate for Payer: United Healthcare HMO Rider |
$129.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: Vantage Medical Group Senior |
$2.08
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
|
OP
|
$19.10
|
|
|
Service Code
|
NDC 0378-9230-93
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.38
|
| Rate for Payer: Blue Distinction Transplant |
$11.46
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$11.15
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.24
|
| Rate for Payer: Dignity Health Media |
$16.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.24
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$15.28
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.55
|
| Rate for Payer: United Healthcare All Other HMO |
$9.55
|
| Rate for Payer: United Healthcare HMO Rider |
$9.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.24
|
| Rate for Payer: Vantage Medical Group Senior |
$16.24
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 0378-9230-93
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$9.78
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.24
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$15.28
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.24
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
|
OP
|
$6.77
|
|
|
Service Code
|
NDC 59762-0118-3
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.03
|
| Rate for Payer: Blue Distinction Transplant |
$4.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.99
|
| Rate for Payer: Blue Shield of California EPN |
$3.95
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$4.74
|
| Rate for Payer: Cigna of CA PPO |
$4.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Media |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.71
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$5.42
|
| Rate for Payer: Networks By Design Commercial |
$4.40
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5.75
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
|
OP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-7
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.18
|
| Rate for Payer: Blue Distinction Transplant |
$4.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.97
|
| Rate for Payer: Dignity Health Media |
$5.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Vantage Medical Group Senior |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
|
IP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-6
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
|
IP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-7
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
|
IP
|
$6.77
|
|
|
Service Code
|
NDC 59762-0118-3
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$3.47
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$4.74
|
| Rate for Payer: Cigna of CA PPO |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.71
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$5.42
|
| Rate for Payer: Networks By Design Commercial |
$4.40
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
|
OP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-6
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.18
|
| Rate for Payer: Blue Distinction Transplant |
$4.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.97
|
| Rate for Payer: Dignity Health Media |
$5.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Vantage Medical Group Senior |
$5.97
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-25
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.44
|
| Rate for Payer: Blue Distinction Transplant |
$7.49
|
| Rate for Payer: Blue Shield of California Commercial |
$9.20
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.61
|
| Rate for Payer: Dignity Health Media |
$10.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.99
|
| Rate for Payer: Galaxy Health WC |
$10.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Networks By Design Commercial |
$8.11
|
| Rate for Payer: Prime Health Services Commercial |
$10.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.24
|
| Rate for Payer: United Healthcare All Other HMO |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.61
|
| Rate for Payer: Vantage Medical Group Senior |
$10.61
|
|
