|
LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE [4457]
|
Facility
OP
|
$3.57
|
|
|
Service Code
|
NDC 0409-4904-34
|
| Hospital Charge Code |
1720132
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.13
|
| Rate for Payer: BCBS Transplant Transplant |
$2.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$2.28
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.03
|
| Rate for Payer: Dignity Health Media |
$3.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$3.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Prime Health Services Commercial |
$3.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.03
|
| Rate for Payer: Vantage Medical Group Senior |
$3.03
|
|
|
LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION [27396]
|
Facility
OP
|
$5.56
|
|
|
Service Code
|
NDC 0409-4712-01
|
| Hospital Charge Code |
1720572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: BCBS Transplant Transplant |
$3.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4.10
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna of CA HMO |
$3.56
|
| Rate for Payer: Cigna of CA PPO |
$4.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.73
|
| Rate for Payer: Dignity Health Media |
$4.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.22
|
| Rate for Payer: Galaxy Health WC |
$4.73
|
| Rate for Payer: Global Benefits Group Commercial |
$3.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$4.45
|
| Rate for Payer: Networks By Design Commercial |
$3.61
|
| Rate for Payer: Prime Health Services Commercial |
$4.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION [27396]
|
Facility
OP
|
$5.56
|
|
|
Service Code
|
NDC 0409-4712-11
|
| Hospital Charge Code |
1720572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: BCBS Transplant Transplant |
$3.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4.10
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna of CA HMO |
$3.56
|
| Rate for Payer: Cigna of CA PPO |
$4.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.73
|
| Rate for Payer: Dignity Health Media |
$4.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.22
|
| Rate for Payer: Galaxy Health WC |
$4.73
|
| Rate for Payer: Global Benefits Group Commercial |
$3.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$4.45
|
| Rate for Payer: Networks By Design Commercial |
$3.61
|
| Rate for Payer: Prime Health Services Commercial |
$4.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION [27396]
|
Facility
IP
|
$5.56
|
|
|
Service Code
|
NDC 0409-4712-01
|
| Hospital Charge Code |
1720572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$2.85
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: Galaxy Health WC |
$4.73
|
| Rate for Payer: Global Benefits Group Commercial |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$4.45
|
| Rate for Payer: Networks By Design Commercial |
$3.61
|
| Rate for Payer: Prime Health Services Commercial |
$4.73
|
|
|
LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION [27396]
|
Facility
IP
|
$5.56
|
|
|
Service Code
|
NDC 0409-4712-11
|
| Hospital Charge Code |
1720572
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$2.85
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: Galaxy Health WC |
$4.73
|
| Rate for Payer: Global Benefits Group Commercial |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$4.45
|
| Rate for Payer: Networks By Design Commercial |
$3.61
|
| Rate for Payer: Prime Health Services Commercial |
$4.73
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [105635]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
NDC 0409-4278-01
|
| Hospital Charge Code |
1721142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [105635]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
NDC 0409-4278-01
|
| Hospital Charge Code |
1721142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14869]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14869]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION - FOR PAIN (LLU) [408148692]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION - FOR PAIN (LLU) [408148692]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV BOLUS [40814869]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV BOLUS [40814869]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV PEDS [4081321]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV PEDS [4081321]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]
|
Facility
IP
|
$1.70
|
|
|
Service Code
|
NDC 0591-2070-30
|
| Hospital Charge Code |
NDG10434
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
|
|
LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]
|
Facility
OP
|
$1.98
|
|
|
Service Code
|
NDC 0168-0357-05
|
| Hospital Charge Code |
NDG10434B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: BCBS Transplant Transplant |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.68
|
| Rate for Payer: Dignity Health Media |
$1.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Vantage Medical Group Senior |
$1.68
|
|
|
LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]
|
Facility
OP
|
$1.70
|
|
|
Service Code
|
NDC 0591-2070-30
|
| Hospital Charge Code |
NDG10434
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: BCBS Transplant Transplant |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.19
|
| Rate for Payer: Cigna of CA PPO |
$1.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.44
|
| Rate for Payer: Dignity Health Media |
$1.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO |
$0.85
|
| Rate for Payer: United Healthcare HMO Rider |
$0.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1.44
|
|
|
LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM [10434]
|
Facility
IP
|
$1.98
|
|
|
Service Code
|
NDC 0168-0357-05
|
| Hospital Charge Code |
NDG10434B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
|
|
LINACLOTIDE 145 MCG CAPSULE [199379]
|
Facility
OP
|
$20.61
|
|
|
Service Code
|
NDC 0456-1201-30
|
| Hospital Charge Code |
ERX199379
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$17.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.28
|
| Rate for Payer: BCBS Transplant Transplant |
$12.37
|
| Rate for Payer: Blue Shield of California Commercial |
$15.19
|
| Rate for Payer: Blue Shield of California EPN |
$12.04
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cigna of CA HMO |
$14.43
|
| Rate for Payer: Cigna of CA PPO |
$14.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.52
|
| Rate for Payer: Dignity Health Media |
$17.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.24
|
| Rate for Payer: Galaxy Health WC |
$17.52
|
| Rate for Payer: Global Benefits Group Commercial |
$12.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$16.49
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Prime Health Services Commercial |
$17.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.30
|
| Rate for Payer: United Healthcare All Other HMO |
$10.30
|
| Rate for Payer: United Healthcare HMO Rider |
$10.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.52
|
| Rate for Payer: Vantage Medical Group Senior |
$17.52
|
|
|
LINACLOTIDE 145 MCG CAPSULE [199379]
|
Facility
IP
|
$20.61
|
|
|
Service Code
|
NDC 0456-1201-30
|
| Hospital Charge Code |
ERX199379
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$17.52 |
| Rate for Payer: Blue Shield of California Commercial |
$14.67
|
| Rate for Payer: Blue Shield of California EPN |
$10.55
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cigna of CA HMO |
$14.43
|
| Rate for Payer: Cigna of CA PPO |
$14.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.24
|
| Rate for Payer: Galaxy Health WC |
$17.52
|
| Rate for Payer: Global Benefits Group Commercial |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$16.49
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Prime Health Services Commercial |
$17.52
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]
|
Facility
IP
|
$5.46
|
|
|
Service Code
|
NDC 0009-5136-01
|
| Hospital Charge Code |
1715979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.80
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$3.82
|
| Rate for Payer: Cigna of CA PPO |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.55
|
| Rate for Payer: Prime Health Services Commercial |
$4.64
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]
|
Facility
OP
|
$5.46
|
|
|
Service Code
|
NDC 0009-5136-01
|
| Hospital Charge Code |
1715979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.25
|
| Rate for Payer: BCBS Transplant Transplant |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$3.82
|
| Rate for Payer: Cigna of CA PPO |
$3.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.64
|
| Rate for Payer: Dignity Health Media |
$4.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.55
|
| Rate for Payer: Prime Health Services Commercial |
$4.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2.73
|
| Rate for Payer: United Healthcare HMO Rider |
$2.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4.64
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]
|
Facility
IP
|
$5.25
|
|
|
Service Code
|
NDC 59762-1308-1
|
| Hospital Charge Code |
1715979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.69
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna of CA HMO |
$3.68
|
| Rate for Payer: Cigna of CA PPO |
$3.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]
|
Facility
OP
|
$5.25
|
|
|
Service Code
|
NDC 59762-1308-1
|
| Hospital Charge Code |
1715979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.13
|
| Rate for Payer: BCBS Transplant Transplant |
$3.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna of CA HMO |
$3.68
|
| Rate for Payer: Cigna of CA PPO |
$3.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.46
|
| Rate for Payer: Dignity Health Media |
$4.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.46
|
|
