|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]
|
Facility
|
IP
|
$0.43
|
|
|
Service Code
|
CPT J7517
|
| Hospital Charge Code |
1711643
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
CPT J7517
|
| Hospital Charge Code |
1711643
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Distinction Transplant |
$0.40
|
| Rate for Payer: Blue Distinction Transplant |
$0.26
|
| Rate for Payer: Blue Distinction Transplant |
$0.33
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Distinction Transplant |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.41
|
| Rate for Payer: Dignity Health Media |
$0.56
|
| Rate for Payer: Dignity Health Media |
$0.47
|
| Rate for Payer: Dignity Health Media |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
CPT J7517
|
| Hospital Charge Code |
1712219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$15.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$15.11
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$15.11
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$18.35
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$12.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$18.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
CPT J7517
|
| Hospital Charge Code |
1712219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Distinction Transplant |
$0.79
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Distinction Transplant |
$0.72
|
| Rate for Payer: Blue Distinction Transplant |
$0.35
|
| Rate for Payer: Blue Distinction Transplant |
$12.95
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$15.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$15.11
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$15.11
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Media |
$0.41
|
| Rate for Payer: Dignity Health Media |
$0.50
|
| Rate for Payer: Dignity Health Media |
$1.12
|
| Rate for Payer: Dignity Health Media |
$1.02
|
| Rate for Payer: Dignity Health Media |
$18.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$18.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$12.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.35
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$10.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$10.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$18.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]
|
Facility
|
OP
|
$7.91
|
|
|
Service Code
|
CPT J7518
|
| Hospital Charge Code |
1712282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Blue Distinction Transplant |
$2.92
|
| Rate for Payer: Blue Distinction Transplant |
$2.68
|
| Rate for Payer: Blue Distinction Transplant |
$0.13
|
| Rate for Payer: Blue Distinction Transplant |
$4.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5.83
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$5.54
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.13
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$5.54
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Media |
$0.19
|
| Rate for Payer: Dignity Health Media |
$6.72
|
| Rate for Payer: Dignity Health Media |
$3.80
|
| Rate for Payer: Dignity Health Media |
$4.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.16
|
| Rate for Payer: Galaxy Health WC |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.93
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Multiplan Commercial |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$3.96
|
| Rate for Payer: Networks By Design Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$3.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$3.96
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6.72
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4.13
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
CPT J7518
|
| Hospital Charge Code |
1712282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$5.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.46
|
| Rate for Payer: Blue Shield of California EPN |
$4.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cigna of CA HMO |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA HMO |
$5.54
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$5.54
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Galaxy Health WC |
$6.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$6.33
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$3.96
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$2.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: Prime Health Services Commercial |
$3.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.48
|
|
|
MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE [38063]
|
Facility
|
OP
|
$5.26
|
|
|
Service Code
|
CPT J7518
|
| Hospital Charge Code |
1712283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Blue Distinction Transplant |
$3.16
|
| Rate for Payer: Blue Distinction Transplant |
$0.27
|
| Rate for Payer: Blue Distinction Transplant |
$0.26
|
| Rate for Payer: Blue Distinction Transplant |
$5.83
|
| Rate for Payer: Blue Distinction Transplant |
$5.48
|
| Rate for Payer: Blue Distinction Transplant |
$9.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$11.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6.73
|
| Rate for Payer: Blue Shield of California Commercial |
$7.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$6.80
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$3.68
|
| Rate for Payer: Cigna of CA HMO |
$6.39
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$6.39
|
| Rate for Payer: Cigna of CA PPO |
$3.68
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$6.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.38
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Media |
$13.44
|
| Rate for Payer: Dignity Health Media |
$4.47
|
| Rate for Payer: Dignity Health Media |
$7.76
|
| Rate for Payer: Dignity Health Media |
$8.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$7.76
|
| Rate for Payer: Galaxy Health WC |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$4.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Global Benefits Group Commercial |
$5.83
|
| Rate for Payer: Global Benefits Group Commercial |
$3.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$12.65
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: Networks By Design Commercial |
$7.90
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.26
|
| Rate for Payer: Prime Health Services Commercial |
$7.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$13.44
|
| Rate for Payer: Prime Health Services Commercial |
$4.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$7.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.86
|
| Rate for Payer: United Healthcare HMO Rider |
$4.56
|
| Rate for Payer: United Healthcare HMO Rider |
$7.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.86
|
| Rate for Payer: United Healthcare HMO Rider |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.76
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.26
|
| Rate for Payer: Vantage Medical Group Senior |
$7.76
|
|
|
MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE [38063]
|
Facility
|
IP
|
$5.26
|
|
|
Service Code
|
CPT J7518
|
| Hospital Charge Code |
1712283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$6.50
|
| Rate for Payer: Blue Shield of California Commercial |
$11.26
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California EPN |
$4.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Blue Shield of California EPN |
$8.09
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$6.39
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA HMO |
$3.68
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$6.80
|
| Rate for Payer: Cigna of CA PPO |
$6.80
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$3.68
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$6.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.65
|
| Rate for Payer: Galaxy Health WC |
$4.47
|
| Rate for Payer: Galaxy Health WC |
$7.76
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$8.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$12.65
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$7.90
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$4.47
|
| Rate for Payer: Prime Health Services Commercial |
$13.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.76
|
| Rate for Payer: Prime Health Services Commercial |
$8.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.97
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3.37
|
| Rate for Payer: United Healthcare All Other HMO |
$5.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.94
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
|
|
Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia
|
Facility
|
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 69421
|
| Min. Negotiated Rate |
$4,022.69 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,516.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,516.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
OP
|
$6.19
|
|
|
Service Code
|
NDC 51079-812-01
|
| Hospital Charge Code |
1711473
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.69
|
| Rate for Payer: Blue Distinction Transplant |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.26
|
| Rate for Payer: Dignity Health Media |
$5.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.48
|
| Rate for Payer: Galaxy Health WC |
$5.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Networks By Design Commercial |
$4.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.26
|
| Rate for Payer: Vantage Medical Group Senior |
$5.26
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
IP
|
$6.19
|
|
|
Service Code
|
NDC 51079-812-01
|
| Hospital Charge Code |
1711473
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Blue Shield of California Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.48
|
| Rate for Payer: Galaxy Health WC |
$5.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Networks By Design Commercial |
$4.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.26
|
|
|
NADOLOL 40 MG TABLET [5331]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 69097-868-07
|
| Hospital Charge Code |
1710788
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
NADOLOL 40 MG TABLET [5331]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 69097-868-07
|
| Hospital Charge Code |
1710788
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
NADOLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080308]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 9994-0803-08
|
| Hospital Charge Code |
1715268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
NADOLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080308]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 9994-0803-08
|
| Hospital Charge Code |
1715268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1751326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Blue Shield of California Commercial |
$85.44
|
| Rate for Payer: Blue Shield of California Commercial |
$95.27
|
| Rate for Payer: Blue Shield of California Commercial |
$120.94
|
| Rate for Payer: Blue Shield of California EPN |
$68.51
|
| Rate for Payer: Blue Shield of California EPN |
$86.97
|
| Rate for Payer: Blue Shield of California EPN |
$61.44
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cigna of CA HMO |
$118.90
|
| Rate for Payer: Cigna of CA HMO |
$93.66
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$93.66
|
| Rate for Payer: Cigna of CA PPO |
$118.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.52
|
| Rate for Payer: Galaxy Health WC |
$113.73
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$144.38
|
| Rate for Payer: Global Benefits Group Commercial |
$101.92
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$80.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.77
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$107.04
|
| Rate for Payer: Multiplan Commercial |
$135.89
|
| Rate for Payer: Networks By Design Commercial |
$66.90
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$84.93
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$113.73
|
| Rate for Payer: Prime Health Services Commercial |
$144.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.31
|
| Rate for Payer: United Healthcare All Other HMO |
$49.35
|
| Rate for Payer: United Healthcare All Other HMO |
$44.26
|
| Rate for Payer: United Healthcare All Other HMO |
$62.64
|
| Rate for Payer: United Healthcare HMO Rider |
$61.29
|
| Rate for Payer: United Healthcare HMO Rider |
$43.30
|
| Rate for Payer: United Healthcare HMO Rider |
$48.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.05
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1751326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Blue Distinction Transplant |
$101.92
|
| Rate for Payer: Blue Distinction Transplant |
$80.28
|
| Rate for Payer: Blue Distinction Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$98.61
|
| Rate for Payer: Blue Shield of California Commercial |
$88.44
|
| Rate for Payer: Blue Shield of California Commercial |
$125.19
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cigna of CA HMO |
$118.90
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$93.66
|
| Rate for Payer: Cigna of CA PPO |
$118.90
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$93.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.38
|
| Rate for Payer: Dignity Health Media |
$113.73
|
| Rate for Payer: Dignity Health Media |
$102.00
|
| Rate for Payer: Dignity Health Media |
$144.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.52
|
| Rate for Payer: Galaxy Health WC |
$144.38
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$113.73
|
| Rate for Payer: Global Benefits Group Commercial |
$80.28
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$101.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$90.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$100.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.11
|
| Rate for Payer: Multiplan Commercial |
$107.04
|
| Rate for Payer: Multiplan Commercial |
$135.89
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$66.90
|
| Rate for Payer: Networks By Design Commercial |
$84.93
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.38
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$113.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.93
|
| Rate for Payer: United Healthcare All Other HMO |
$84.93
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.90
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.90
|
| Rate for Payer: United Healthcare HMO Rider |
$84.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.38
|
| Rate for Payer: Vantage Medical Group Senior |
$144.38
|
| Rate for Payer: Vantage Medical Group Senior |
$113.73
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
NAFCILLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [10681]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
NDG10681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
|
|
NAFCILLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [10681]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
NDG10681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$77.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Blue Distinction Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Media |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| 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 |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1720545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Blue Shield of California Commercial |
$9.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.72
|
| Rate for Payer: Blue Shield of California Commercial |
$9.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9.83
|
| Rate for Payer: Blue Shield of California EPN |
$6.91
|
| Rate for Payer: Blue Shield of California EPN |
$7.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.76
|
| Rate for Payer: Blue Shield of California EPN |
$9.15
|
| Rate for Payer: Blue Shield of California EPN |
$7.19
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cigna of CA HMO |
$12.51
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$9.83
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$12.51
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.52
|
| Rate for Payer: Galaxy Health WC |
$15.19
|
| Rate for Payer: Galaxy Health WC |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$11.93
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$14.30
|
| Rate for Payer: Multiplan Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$8.94
|
| Rate for Payer: Prime Health Services Commercial |
$11.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$11.48
|
| Rate for Payer: Prime Health Services Commercial |
$15.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.98
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.09
|
| Rate for Payer: United Healthcare All Other HMO |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO |
$6.59
|
| Rate for Payer: United Healthcare HMO Rider |
$6.45
|
| Rate for Payer: United Healthcare HMO Rider |
$5.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1720545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$77.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Blue Distinction Transplant |
$8.28
|
| Rate for Payer: Blue Distinction Transplant |
$8.10
|
| Rate for Payer: Blue Distinction Transplant |
$7.92
|
| Rate for Payer: Blue Distinction Transplant |
$10.72
|
| Rate for Payer: Blue Distinction Transplant |
$8.42
|
| Rate for Payer: Blue Shield of California Commercial |
$13.17
|
| Rate for Payer: Blue Shield of California Commercial |
$10.17
|
| Rate for Payer: Blue Shield of California Commercial |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$10.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9.95
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cigna of CA HMO |
$9.83
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$12.51
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Cigna of CA PPO |
$12.51
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Media |
$11.22
|
| Rate for Payer: Dignity Health Media |
$11.93
|
| Rate for Payer: Dignity Health Media |
$15.19
|
| Rate for Payer: Dignity Health Media |
$11.48
|
| Rate for Payer: Dignity Health Media |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.15
|
| Rate for Payer: Galaxy Health WC |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$15.19
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Galaxy Health WC |
$11.93
|
| Rate for Payer: Global Benefits Group Commercial |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Multiplan Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$14.30
|
| Rate for Payer: Multiplan Commercial |
$11.23
|
| Rate for Payer: Networks By Design Commercial |
$8.94
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$6.75
|
| Rate for Payer: Prime Health Services Commercial |
$11.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$11.48
|
| Rate for Payer: Prime Health Services Commercial |
$15.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO |
$6.75
|
| Rate for Payer: United Healthcare All Other HMO |
$7.02
|
| Rate for Payer: United Healthcare All Other HMO |
$8.94
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$7.02
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare HMO Rider |
$6.90
|
| Rate for Payer: United Healthcare HMO Rider |
$6.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.48
|
| Rate for Payer: Vantage Medical Group Senior |
$15.19
|
| Rate for Payer: Vantage Medical Group Senior |
$11.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11.48
|
| Rate for Payer: Vantage Medical Group Senior |
$11.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]
|
Facility
|
IP
|
$26.04
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1751022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Blue Shield of California Commercial |
$18.54
|
| Rate for Payer: Blue Shield of California Commercial |
$18.80
|
| Rate for Payer: Blue Shield of California Commercial |
$24.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Blue Shield of California EPN |
$17.75
|
| Rate for Payer: Blue Shield of California EPN |
$13.33
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna of CA HMO |
$24.27
|
| Rate for Payer: Cigna of CA HMO |
$18.48
|
| Rate for Payer: Cigna of CA HMO |
$18.23
|
| Rate for Payer: Cigna of CA PPO |
$18.23
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$24.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.56
|
| Rate for Payer: Galaxy Health WC |
$22.44
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Galaxy Health WC |
$29.47
|
| Rate for Payer: Global Benefits Group Commercial |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$15.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$20.83
|
| Rate for Payer: Multiplan Commercial |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$27.74
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Networks By Design Commercial |
$17.34
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$22.44
|
| Rate for Payer: Prime Health Services Commercial |
$29.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.83
|
| Rate for Payer: United Healthcare All Other HMO |
$9.74
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.40
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]
|
Facility
|
OP
|
$26.04
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1751022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$77.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.24
|
| Rate for Payer: Blue Distinction Transplant |
$20.80
|
| Rate for Payer: Blue Distinction Transplant |
$15.84
|
| Rate for Payer: Blue Distinction Transplant |
$15.62
|
| Rate for Payer: Blue Shield of California Commercial |
$19.46
|
| Rate for Payer: Blue Shield of California Commercial |
$19.19
|
| Rate for Payer: Blue Shield of California Commercial |
$25.55
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna of CA HMO |
$24.27
|
| Rate for Payer: Cigna of CA HMO |
$18.23
|
| Rate for Payer: Cigna of CA HMO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$24.27
|
| Rate for Payer: Cigna of CA PPO |
$18.23
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.47
|
| Rate for Payer: Dignity Health Media |
$22.44
|
| Rate for Payer: Dignity Health Media |
$22.13
|
| Rate for Payer: Dignity Health Media |
$29.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.56
|
| Rate for Payer: Galaxy Health WC |
$29.47
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Galaxy Health WC |
$22.44
|
| Rate for Payer: Global Benefits Group Commercial |
$15.84
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$27.74
|
| Rate for Payer: Multiplan Commercial |
$20.83
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Networks By Design Commercial |
$17.34
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$29.47
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$22.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO |
$13.02
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.02
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$17.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
1759515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$33.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.71
|
| Rate for Payer: Blue Distinction Transplant |
$2.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.15
|
| Rate for Payer: Blue Shield of California EPN |
$3.86
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna of CA HMO |
$3.00
|
| Rate for Payer: Cigna of CA PPO |
$3.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.64
|
| Rate for Payer: Dignity Health Media |
$3.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.64
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
1720255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Blue Shield of California Commercial |
$3.46
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Networks By Design Commercial |
$2.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
|
