|
MEPERIDINE 50 MG/ML INJECTION SOLUTION [110376]
|
Facility
IP
|
$4.13
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
NDG110376
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Blue Shield of California Commercial |
$2.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cigna of CA HMO |
$2.89
|
| Rate for Payer: Cigna of CA PPO |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.65
|
| Rate for Payer: Galaxy Health WC |
$3.51
|
| Rate for Payer: Global Benefits Group Commercial |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.51
|
|
|
MEPERIDINE (PF) 100 MG/2 ML INJECTION SOLUTION [108100]
|
Facility
IP
|
$2.78
|
|
|
Service Code
|
NDC 0409-1255-12
|
| Hospital Charge Code |
NDG108100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$2.36
|
|
|
MEPERIDINE (PF) 100 MG/2 ML INJECTION SOLUTION [108100]
|
Facility
IP
|
$2.78
|
|
|
Service Code
|
NDC 0409-1255-02
|
| Hospital Charge Code |
NDG108100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$2.36
|
|
|
MEPERIDINE (PF) 100 MG/2 ML INJECTION SOLUTION [108100]
|
Facility
OP
|
$2.78
|
|
|
Service Code
|
NDC 0409-1255-02
|
| Hospital Charge Code |
NDG108100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.66
|
| Rate for Payer: BCBS Transplant Transplant |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.36
|
| Rate for Payer: Dignity Health Media |
$2.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$2.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2.36
|
|
|
MEPERIDINE (PF) 100 MG/2 ML INJECTION SOLUTION [108100]
|
Facility
OP
|
$2.78
|
|
|
Service Code
|
NDC 0409-1255-12
|
| Hospital Charge Code |
NDG108100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.66
|
| Rate for Payer: BCBS Transplant Transplant |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.36
|
| Rate for Payer: Dignity Health Media |
$2.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$2.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2.36
|
|
|
MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [117787]
|
Facility
OP
|
$3.04
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
NDG117787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: BCBS Transplant Transplant |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
| Rate for Payer: Dignity Health Media |
$2.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.52
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
| Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
|
MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION [117787]
|
Facility
IP
|
$3.04
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
NDG117787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$2.13
|
| Rate for Payer: Cigna of CA PPO |
$2.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Networks By Design Commercial |
$1.52
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION [4904]
|
Facility
OP
|
$3.17
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
1737004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: BCBS Transplant Transplant |
$1.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$2.22
|
| Rate for Payer: Cigna of CA PPO |
$2.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.69
|
| Rate for Payer: Dignity Health Media |
$2.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.27
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION [4904]
|
Facility
IP
|
$3.17
|
|
|
Service Code
|
CPT J2175
|
| Hospital Charge Code |
1737004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$2.22
|
| Rate for Payer: Cigna of CA PPO |
$2.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.27
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
|
|
MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION [10529]
|
Facility
IP
|
$0.47
|
|
|
Service Code
|
CPT J0670
|
| Hospital Charge Code |
1720267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
|
|
MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION [10529]
|
Facility
OP
|
$0.47
|
|
|
Service Code
|
CPT J0670
|
| Hospital Charge Code |
1720267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: Dignity Health Media |
$0.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [105638]
|
Facility
IP
|
$0.57
|
|
|
Service Code
|
CPT J0670
|
| Hospital Charge Code |
1720276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [105638]
|
Facility
OP
|
$0.57
|
|
|
Service Code
|
CPT J0670
|
| Hospital Charge Code |
1720276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
MEPIVACAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [4081086]
|
Facility
OP
|
$0.57
|
|
|
Service Code
|
CPT J0670
|
| Hospital Charge Code |
NDC4081086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
MEPIVACAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [4081086]
|
Facility
IP
|
$0.57
|
|
|
Service Code
|
CPT J0670
|
| Hospital Charge Code |
NDC4081086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]
|
Facility
IP
|
$4,033.58
|
|
|
Service Code
|
CPT J2182
|
| Hospital Charge Code |
ERX211796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$968.06 |
| Max. Negotiated Rate |
$3,428.54 |
| Rate for Payer: Blue Shield of California Commercial |
$2,871.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,065.19
|
| Rate for Payer: Cash Price |
$1,815.11
|
| Rate for Payer: Cigna of CA HMO |
$2,823.51
|
| Rate for Payer: Cigna of CA PPO |
$2,823.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,613.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,613.43
|
| Rate for Payer: Galaxy Health WC |
$3,428.54
|
| Rate for Payer: Global Benefits Group Commercial |
$2,420.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,690.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,536.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.06
|
| Rate for Payer: Multiplan Commercial |
$3,226.86
|
| Rate for Payer: Networks By Design Commercial |
$2,016.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,428.54
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]
|
Facility
OP
|
$4,033.58
|
|
|
Service Code
|
CPT J2182
|
| Hospital Charge Code |
ERX211796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$3,428.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$191.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.85
|
| Rate for Payer: BCBS Transplant Transplant |
$2,420.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,972.75
|
| Rate for Payer: Blue Shield of California EPN |
$36.89
|
| Rate for Payer: Cash Price |
$1,815.11
|
| Rate for Payer: Cash Price |
$1,815.11
|
| Rate for Payer: Cigna of CA HMO |
$2,823.51
|
| Rate for Payer: Cigna of CA PPO |
$2,823.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.76
|
| Rate for Payer: Dignity Health Media |
$30.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.50
|
| Rate for Payer: Galaxy Health WC |
$3,428.54
|
| Rate for Payer: Global Benefits Group Commercial |
$2,420.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,025.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$50.03
|
| Rate for Payer: IEHP Medi-Cal |
$49.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$49.42
|
| Rate for Payer: IEHP Medicare Advantage |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,690.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.88
|
| Rate for Payer: Multiplan Commercial |
$3,226.86
|
| Rate for Payer: Networks By Design Commercial |
$2,016.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,428.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,420.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,420.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,016.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2,016.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2,016.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,016.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.56
|
| Rate for Payer: Vantage Medical Group Senior |
$30.50
|
|
|
MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [206120]
|
Facility
IP
|
$17.20
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
NDG206120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Blue Shield of California Commercial |
$12.25
|
| Rate for Payer: Blue Shield of California EPN |
$8.81
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cigna of CA HMO |
$12.04
|
| Rate for Payer: Cigna of CA PPO |
$12.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.88
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$8.60
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
|
|
MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [206120]
|
Facility
OP
|
$17.20
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
NDG206120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.08
|
| Rate for Payer: BCBS Transplant Transplant |
$10.32
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cigna of CA HMO |
$12.04
|
| Rate for Payer: Cigna of CA PPO |
$12.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.62
|
| Rate for Payer: Dignity Health Media |
$14.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.88
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$8.60
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.60
|
| Rate for Payer: United Healthcare All Other HMO |
$8.60
|
| Rate for Payer: United Healthcare HMO Rider |
$8.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.62
|
| Rate for Payer: Vantage Medical Group Senior |
$14.62
|
|
|
MERCAPTOPURINE 25 MG 1/2 TAB [192268]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1712421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.08
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Media |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
MERCAPTOPURINE 25 MG 1/2 TAB [192268]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1712421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
MERCAPTOPURINE 50 MG TABLET [10531]
|
Facility
IP
|
$3.80
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1711074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Networks By Design Commercial |
$2.47
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
|
|
MERCAPTOPURINE 50 MG TABLET [10531]
|
Facility
OP
|
$3.80
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1711074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.08
|
| Rate for Payer: BCBS Transplant Transplant |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.23
|
| Rate for Payer: Dignity Health Media |
$3.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.04
|
| Rate for Payer: Networks By Design Commercial |
$2.47
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.23
|
| Rate for Payer: Vantage Medical Group Senior |
$3.23
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]
|
Facility
IP
|
$22.01
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
ERX17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.91
|
| Rate for Payer: Blue Shield of California Commercial |
$17.09
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$25.63
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Blue Shield of California EPN |
$11.27
|
| Rate for Payer: Blue Shield of California EPN |
$12.72
|
| Rate for Payer: Blue Shield of California EPN |
$12.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.53
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$15.41
|
| Rate for Payer: Cigna of CA HMO |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$17.40
|
| Rate for Payer: Cigna of CA PPO |
$15.41
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$17.40
|
| Rate for Payer: Cigna of CA PPO |
$4.83
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Galaxy Health WC |
$5.86
|
| Rate for Payer: Galaxy Health WC |
$18.71
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$4.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$17.61
|
| Rate for Payer: Multiplan Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$19.88
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$3.45
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$18.71
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$5.86
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]
|
Facility
OP
|
$22.01
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
ERX17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.22
|
| Rate for Payer: BCBS Transplant Transplant |
$14.40
|
| Rate for Payer: BCBS Transplant Transplant |
$4.14
|
| Rate for Payer: BCBS Transplant Transplant |
$21.60
|
| Rate for Payer: BCBS Transplant Transplant |
$14.91
|
| Rate for Payer: BCBS Transplant Transplant |
$13.21
|
| Rate for Payer: Blue Shield of California Commercial |
$16.22
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5.09
|
| Rate for Payer: Blue Shield of California Commercial |
$26.53
|
| Rate for Payer: Blue Shield of California Commercial |
$18.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cigna of CA HMO |
$15.41
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$17.40
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$4.83
|
| Rate for Payer: Cigna of CA PPO |
$15.41
|
| Rate for Payer: Cigna of CA PPO |
$17.40
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$4.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.12
|
| Rate for Payer: Dignity Health Media |
$21.12
|
| Rate for Payer: Dignity Health Media |
$18.71
|
| Rate for Payer: Dignity Health Media |
$20.40
|
| Rate for Payer: Dignity Health Media |
$30.60
|
| Rate for Payer: Dignity Health Media |
$5.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$18.71
|
| Rate for Payer: Galaxy Health WC |
$5.86
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4.14
|
| Rate for Payer: Global Benefits Group Commercial |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$19.88
|
| Rate for Payer: Multiplan Commercial |
$17.61
|
| Rate for Payer: Multiplan Commercial |
$5.52
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$3.45
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$18.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.45
|
| Rate for Payer: United Healthcare HMO Rider |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$11.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$18.71
|
| Rate for Payer: Vantage Medical Group Senior |
$21.12
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5.86
|
|
