|
MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
1753510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.80
|
| 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: BCBS Transplant Transplant |
$7.42
|
| Rate for Payer: BCBS Transplant Transplant |
$6.60
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California Commercial |
$8.11
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$8.65
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.65
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Media |
$9.35
|
| Rate for Payer: Dignity Health Media |
$10.20
|
| Rate for Payer: Dignity Health Media |
$10.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$10.51
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$9.89
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.50
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$10.51
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.18
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.51
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]
|
Facility
IP
|
$11.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
1753510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$8.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Blue Shield of California EPN |
$6.33
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$8.65
|
| Rate for Payer: Cigna of CA PPO |
$8.65
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$10.51
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7.42
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$5.50
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Prime Health Services Commercial |
$10.51
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]
|
Facility
OP
|
$259.20
|
|
|
Service Code
|
CPT J2186
|
| Hospital Charge Code |
ERX219863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.45
|
| Rate for Payer: BCBS Transplant Transplant |
$155.52
|
| Rate for Payer: Blue Shield of California Commercial |
$191.03
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cigna of CA HMO |
$181.44
|
| Rate for Payer: Cigna of CA PPO |
$181.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.11
|
| Rate for Payer: Dignity Health Media |
$2.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$220.32
|
| Rate for Payer: Global Benefits Group Commercial |
$155.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$194.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.40
|
| Rate for Payer: IEHP Medi-Cal |
$3.36
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.36
|
| Rate for Payer: IEHP Medicare Advantage |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$207.36
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$220.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Other HMO |
$129.60
|
| Rate for Payer: United Healthcare HMO Rider |
$129.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: Vantage Medical Group Senior |
$2.08
|
|
|
MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]
|
Facility
IP
|
$259.20
|
|
|
Service Code
|
CPT J2186
|
| Hospital Charge Code |
ERX219863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Blue Shield of California Commercial |
$184.55
|
| Rate for Payer: Blue Shield of California EPN |
$132.71
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cigna of CA HMO |
$181.44
|
| Rate for Payer: Cigna of CA PPO |
$181.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$103.68
|
| Rate for Payer: Galaxy Health WC |
$220.32
|
| Rate for Payer: Global Benefits Group Commercial |
$155.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.21
|
| Rate for Payer: Multiplan Commercial |
$207.36
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$220.32
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$19.10
|
|
|
Service Code
|
NDC 0378-9230-93
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.38
|
| Rate for Payer: BCBS Transplant Transplant |
$11.46
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$11.15
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.24
|
| Rate for Payer: Dignity Health Media |
$16.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.24
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$15.28
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.55
|
| Rate for Payer: United Healthcare All Other HMO |
$9.55
|
| Rate for Payer: United Healthcare HMO Rider |
$9.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.24
|
| Rate for Payer: Vantage Medical Group Senior |
$16.24
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-7
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.18
|
| Rate for Payer: BCBS Transplant Transplant |
$4.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.97
|
| Rate for Payer: Dignity Health Media |
$5.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Vantage Medical Group Senior |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-6
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-7
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$6.77
|
|
|
Service Code
|
NDC 59762-0118-3
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.03
|
| Rate for Payer: BCBS Transplant Transplant |
$4.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.99
|
| Rate for Payer: Blue Shield of California EPN |
$3.95
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$4.74
|
| Rate for Payer: Cigna of CA PPO |
$4.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Media |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.71
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$5.42
|
| Rate for Payer: Networks By Design Commercial |
$4.40
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5.75
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$6.77
|
|
|
Service Code
|
NDC 59762-0118-3
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$3.47
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$4.74
|
| Rate for Payer: Cigna of CA PPO |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.71
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$5.42
|
| Rate for Payer: Networks By Design Commercial |
$4.40
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$19.10
|
|
|
Service Code
|
NDC 0378-9230-93
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$9.78
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.24
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$15.28
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.24
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-6
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Vantage Medical Group Senior |
$5.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.18
|
| Rate for Payer: BCBS Transplant Transplant |
$4.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.97
|
| Rate for Payer: Dignity Health Media |
$5.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.97
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-25
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Blue Shield of California Commercial |
$8.89
|
| Rate for Payer: Blue Shield of California EPN |
$6.39
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.99
|
| Rate for Payer: Galaxy Health WC |
$10.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Networks By Design Commercial |
$8.11
|
| Rate for Payer: Prime Health Services Commercial |
$10.61
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$2.67
|
|
|
Service Code
|
NDC 0378-7401-78
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.87
|
| Rate for Payer: Cigna of CA PPO |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$2.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.27
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-95
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Blue Shield of California Commercial |
$8.89
|
| Rate for Payer: Blue Shield of California EPN |
$6.39
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.99
|
| Rate for Payer: Galaxy Health WC |
$10.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Networks By Design Commercial |
$8.11
|
| Rate for Payer: Prime Health Services Commercial |
$10.61
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$11.23
|
|
|
Service Code
|
NDC 54092-476-12
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Blue Shield of California Commercial |
$8.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-25
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.44
|
| Rate for Payer: BCBS Transplant Transplant |
$7.49
|
| Rate for Payer: Blue Shield of California Commercial |
$9.20
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.61
|
| Rate for Payer: Dignity Health Media |
$10.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.99
|
| Rate for Payer: Galaxy Health WC |
$10.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Networks By Design Commercial |
$8.11
|
| Rate for Payer: Prime Health Services Commercial |
$10.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.24
|
| Rate for Payer: United Healthcare All Other HMO |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.61
|
| Rate for Payer: Vantage Medical Group Senior |
$10.61
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$2.67
|
|
|
Service Code
|
NDC 0378-7401-78
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.59
|
| Rate for Payer: BCBS Transplant Transplant |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.87
|
| Rate for Payer: Cigna of CA PPO |
$1.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$2.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$11.23
|
|
|
Service Code
|
NDC 54092-476-12
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: BCBS Transplant Transplant |
$6.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.69
|
| Rate for Payer: Blue Shield of California Commercial |
$8.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.56
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Media |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO |
$5.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-95
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.44
|
| Rate for Payer: BCBS Transplant Transplant |
$7.49
|
| Rate for Payer: Blue Shield of California Commercial |
$9.20
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.61
|
| Rate for Payer: Dignity Health Media |
$10.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.99
|
| Rate for Payer: Galaxy Health WC |
$10.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Networks By Design Commercial |
$8.11
|
| Rate for Payer: Prime Health Services Commercial |
$10.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.24
|
| Rate for Payer: United Healthcare All Other HMO |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.61
|
| Rate for Payer: Vantage Medical Group Senior |
$10.61
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$5.34
|
|
|
Service Code
|
NDC 63304-175-13
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Blue Shield of California Commercial |
$3.80
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$3.74
|
| Rate for Payer: Cigna of CA PPO |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.54
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Networks By Design Commercial |
$3.47
|
| Rate for Payer: Prime Health Services Commercial |
$4.54
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$5.34
|
|
|
Service Code
|
NDC 63304-175-13
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Galaxy Health WC |
$4.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.18
|
| Rate for Payer: BCBS Transplant Transplant |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$3.74
|
| Rate for Payer: Cigna of CA PPO |
$3.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.54
|
| Rate for Payer: Dignity Health Media |
$4.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Networks By Design Commercial |
$3.47
|
| Rate for Payer: Prime Health Services Commercial |
$4.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: Vantage Medical Group Senior |
$4.54
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE) [214804]
|
Facility
OP
|
$4.66
|
|
|
Service Code
|
NDC 0023-5853-18
|
| Hospital Charge Code |
ERX214804
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.78
|
| Rate for Payer: BCBS Transplant Transplant |
$2.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.96
|
| Rate for Payer: Dignity Health Media |
$3.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.86
|
| Rate for Payer: Galaxy Health WC |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
| Rate for Payer: Networks By Design Commercial |
$3.03
|
| Rate for Payer: Prime Health Services Commercial |
$3.96
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3.96
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE) [214804]
|
Facility
IP
|
$4.66
|
|
|
Service Code
|
NDC 0023-5853-18
|
| Hospital Charge Code |
ERX214804
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Galaxy Health WC |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
| Rate for Payer: Networks By Design Commercial |
$3.03
|
| Rate for Payer: Prime Health Services Commercial |
$3.96
|
|
|
MESALAMINE 4 GRAM/60 ML ENEMA [10535]
|
Facility
OP
|
$0.27
|
|
|
Service Code
|
NDC 62559-420-07
|
| Hospital Charge Code |
1748078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
