|
POLYOXYL (100) STEARYL ETHER (BULK) 100 % WAX [192296]
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
NDC 5192723020
|
| Hospital Charge Code |
NDG192296
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Blue Distinction Transplant |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.47
|
| Rate for Payer: Dignity Health Media |
$1.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.87
|
| Rate for Payer: United Healthcare HMO Rider |
$0.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1.47
|
|
|
POLYVINYL ALCOHOL 1.4 % EYE DROPS [27994]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
NDC 17478-060-12
|
| Hospital Charge Code |
1740338
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Distinction Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| 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) Other |
$0.35
|
| 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 |
$0.31
|
| 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
|
|
|
POLYVINYL ALCOHOL 1.4 % EYE DROPS [27994]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 17478-060-12
|
| Hospital Charge Code |
1740338
|
|
Hospital Revenue Code
|
259
|
| 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: 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 |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
|
|
PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION [27047]
|
Facility
|
OP
|
$435.45
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.51 |
| Max. Negotiated Rate |
$370.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$285.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.50
|
| Rate for Payer: Blue Distinction Transplant |
$261.27
|
| Rate for Payer: Blue Shield of California Commercial |
$320.93
|
| Rate for Payer: Blue Shield of California EPN |
$254.30
|
| Rate for Payer: Cash Price |
$195.95
|
| Rate for Payer: Cigna of CA HMO |
$304.82
|
| Rate for Payer: Cigna of CA PPO |
$304.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.13
|
| Rate for Payer: Dignity Health Media |
$370.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$370.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$174.18
|
| Rate for Payer: Galaxy Health WC |
$370.13
|
| Rate for Payer: Global Benefits Group Commercial |
$261.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$326.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.51
|
| Rate for Payer: Multiplan Commercial |
$348.36
|
| Rate for Payer: Networks By Design Commercial |
$217.72
|
| Rate for Payer: Prime Health Services Commercial |
$370.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.72
|
| Rate for Payer: United Healthcare All Other HMO |
$217.72
|
| Rate for Payer: United Healthcare HMO Rider |
$217.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$370.13
|
| Rate for Payer: Vantage Medical Group Senior |
$370.13
|
|
|
PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION [27047]
|
Facility
|
IP
|
$435.45
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.51 |
| Max. Negotiated Rate |
$370.13 |
| Rate for Payer: Blue Shield of California Commercial |
$310.04
|
| Rate for Payer: Blue Shield of California EPN |
$222.95
|
| Rate for Payer: Cash Price |
$195.95
|
| Rate for Payer: Cigna of CA HMO |
$304.82
|
| Rate for Payer: Cigna of CA PPO |
$304.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$174.18
|
| Rate for Payer: Galaxy Health WC |
$370.13
|
| Rate for Payer: Global Benefits Group Commercial |
$261.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.51
|
| Rate for Payer: Multiplan Commercial |
$348.36
|
| Rate for Payer: Networks By Design Commercial |
$217.72
|
| Rate for Payer: Prime Health Services Commercial |
$370.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.43
|
| Rate for Payer: United Healthcare All Other HMO |
$160.59
|
| Rate for Payer: United Healthcare HMO Rider |
$157.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.70
|
|
|
PORACTANT ALFA 240 MG/3 ML INTRATRACHEAL SUSPENSION [117872]
|
Facility
|
OP
|
$429.33
|
|
|
Service Code
|
NDC 10122-510-03
|
| Hospital Charge Code |
1720929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$364.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$281.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$364.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.79
|
| Rate for Payer: Blue Distinction Transplant |
$257.60
|
| Rate for Payer: Blue Shield of California Commercial |
$316.42
|
| Rate for Payer: Blue Shield of California EPN |
$250.73
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna of CA HMO |
$274.77
|
| Rate for Payer: Cigna of CA PPO |
$317.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.93
|
| Rate for Payer: Dignity Health Media |
$364.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.73
|
| Rate for Payer: Galaxy Health WC |
$364.93
|
| Rate for Payer: Global Benefits Group Commercial |
$257.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$322.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$343.46
|
| Rate for Payer: Networks By Design Commercial |
$279.06
|
| Rate for Payer: Prime Health Services Commercial |
$364.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.66
|
| Rate for Payer: United Healthcare All Other HMO |
$214.66
|
| Rate for Payer: United Healthcare HMO Rider |
$214.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.93
|
| Rate for Payer: Vantage Medical Group Senior |
$364.93
|
|
|
PORACTANT ALFA 240 MG/3 ML INTRATRACHEAL SUSPENSION [117872]
|
Facility
|
IP
|
$429.33
|
|
|
Service Code
|
NDC 10122-510-03
|
| Hospital Charge Code |
1720929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$364.93 |
| Rate for Payer: Blue Shield of California Commercial |
$305.68
|
| Rate for Payer: Blue Shield of California EPN |
$219.82
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.73
|
| Rate for Payer: Galaxy Health WC |
$364.93
|
| Rate for Payer: Global Benefits Group Commercial |
$257.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$343.46
|
| Rate for Payer: Networks By Design Commercial |
$279.06
|
| Rate for Payer: Prime Health Services Commercial |
$364.93
|
|
|
PORFIMER 75 MG INTRAVENOUS SOLUTION [14472]
|
Facility
|
IP
|
$25,980.00
|
|
|
Service Code
|
CPT J9600
|
| Hospital Charge Code |
ERX14472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,235.20 |
| Max. Negotiated Rate |
$22,083.00 |
| Rate for Payer: Blue Shield of California Commercial |
$18,497.76
|
| Rate for Payer: Blue Shield of California EPN |
$13,301.76
|
| Rate for Payer: Cash Price |
$11,691.00
|
| Rate for Payer: Cigna of CA HMO |
$18,186.00
|
| Rate for Payer: Cigna of CA PPO |
$18,186.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,392.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,392.00
|
| Rate for Payer: Galaxy Health WC |
$22,083.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,588.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,898.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,235.20
|
| Rate for Payer: Multiplan Commercial |
$20,784.00
|
| Rate for Payer: Networks By Design Commercial |
$12,990.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,083.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,810.05
|
| Rate for Payer: United Healthcare All Other HMO |
$9,581.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9,373.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,573.40
|
|
|
PORFIMER 75 MG INTRAVENOUS SOLUTION [14472]
|
Facility
|
OP
|
$25,980.00
|
|
|
Service Code
|
CPT J9600
|
| Hospital Charge Code |
ERX14472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,590.46 |
| Max. Negotiated Rate |
$138,342.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138,342.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28,535.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,110.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,110.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,590.46
|
| Rate for Payer: Blue Distinction Transplant |
$15,588.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,147.26
|
| Rate for Payer: Blue Shield of California EPN |
$25,248.00
|
| Rate for Payer: Cash Price |
$11,691.00
|
| Rate for Payer: Cash Price |
$11,691.00
|
| Rate for Payer: Cigna of CA HMO |
$18,186.00
|
| Rate for Payer: Cigna of CA PPO |
$18,186.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,242.24
|
| Rate for Payer: Dignity Health Media |
$22,828.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,110.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,818.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,828.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$22,828.16
|
| Rate for Payer: Galaxy Health WC |
$22,083.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,588.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19,485.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,438.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$37,438.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36,981.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$36,981.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,828.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,898.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,828.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,235.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,763.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,589.73
|
| Rate for Payer: Multiplan Commercial |
$20,784.00
|
| Rate for Payer: Networks By Design Commercial |
$12,990.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,083.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,588.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,588.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,990.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,990.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,990.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,990.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,242.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,110.98
|
| Rate for Payer: Vantage Medical Group Senior |
$22,828.16
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$56.60
|
|
|
Service Code
|
NDC 60687-523-11
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$48.11 |
| Rate for Payer: Blue Shield of California Commercial |
$40.30
|
| Rate for Payer: Blue Shield of California EPN |
$28.98
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$39.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.11
|
| Rate for Payer: Global Benefits Group Commercial |
$33.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$45.28
|
| Rate for Payer: Networks By Design Commercial |
$36.79
|
| Rate for Payer: Prime Health Services Commercial |
$48.11
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$56.60
|
|
|
Service Code
|
NDC 60687-523-11
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$48.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.72
|
| Rate for Payer: Blue Distinction Transplant |
$33.96
|
| Rate for Payer: Blue Shield of California Commercial |
$41.71
|
| Rate for Payer: Blue Shield of California EPN |
$33.05
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$39.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.11
|
| Rate for Payer: Dignity Health Media |
$48.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.11
|
| Rate for Payer: Global Benefits Group Commercial |
$33.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$45.28
|
| Rate for Payer: Networks By Design Commercial |
$36.79
|
| Rate for Payer: Prime Health Services Commercial |
$48.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.30
|
| Rate for Payer: United Healthcare All Other HMO |
$28.30
|
| Rate for Payer: United Healthcare HMO Rider |
$28.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.11
|
| Rate for Payer: Vantage Medical Group Senior |
$48.11
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$82.24
|
|
|
Service Code
|
NDC 0085-4324-02
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$69.90 |
| Rate for Payer: Blue Shield of California Commercial |
$58.55
|
| Rate for Payer: Blue Shield of California EPN |
$42.11
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Cigna of CA HMO |
$57.57
|
| Rate for Payer: Cigna of CA PPO |
$57.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.90
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Multiplan Commercial |
$65.79
|
| Rate for Payer: Networks By Design Commercial |
$53.46
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$56.60
|
|
|
Service Code
|
NDC 60687-523-21
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$48.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.72
|
| Rate for Payer: Blue Distinction Transplant |
$33.96
|
| Rate for Payer: Blue Shield of California Commercial |
$41.71
|
| Rate for Payer: Blue Shield of California EPN |
$33.05
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$39.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.11
|
| Rate for Payer: Dignity Health Media |
$48.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.11
|
| Rate for Payer: Global Benefits Group Commercial |
$33.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$45.28
|
| Rate for Payer: Networks By Design Commercial |
$36.79
|
| Rate for Payer: Prime Health Services Commercial |
$48.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.30
|
| Rate for Payer: United Healthcare All Other HMO |
$28.30
|
| Rate for Payer: United Healthcare HMO Rider |
$28.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.11
|
| Rate for Payer: Vantage Medical Group Senior |
$48.11
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$19.24
|
|
|
Service Code
|
NDC 0527-2133-35
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.46
|
| Rate for Payer: Blue Distinction Transplant |
$11.54
|
| Rate for Payer: Blue Shield of California Commercial |
$14.18
|
| Rate for Payer: Blue Shield of California EPN |
$11.24
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cigna of CA HMO |
$13.47
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.35
|
| Rate for Payer: Dignity Health Media |
$16.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.70
|
| Rate for Payer: Galaxy Health WC |
$16.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$15.39
|
| Rate for Payer: Networks By Design Commercial |
$12.51
|
| Rate for Payer: Prime Health Services Commercial |
$16.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.62
|
| Rate for Payer: United Healthcare All Other HMO |
$9.62
|
| Rate for Payer: United Healthcare HMO Rider |
$9.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16.35
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 70748-258-07
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.36
|
| Rate for Payer: Blue Distinction Transplant |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.63
|
| Rate for Payer: Blue Shield of California EPN |
$5.26
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Media |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$56.60
|
|
|
Service Code
|
NDC 60687-523-21
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$48.11 |
| Rate for Payer: Blue Shield of California Commercial |
$40.30
|
| Rate for Payer: Blue Shield of California EPN |
$28.98
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$39.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.11
|
| Rate for Payer: Global Benefits Group Commercial |
$33.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$45.28
|
| Rate for Payer: Networks By Design Commercial |
$36.79
|
| Rate for Payer: Prime Health Services Commercial |
$48.11
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 70748-258-07
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Blue Shield of California Commercial |
$6.41
|
| Rate for Payer: Blue Shield of California EPN |
$4.61
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$82.24
|
|
|
Service Code
|
NDC 0085-4324-02
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$69.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.00
|
| Rate for Payer: Blue Distinction Transplant |
$49.34
|
| Rate for Payer: Blue Shield of California Commercial |
$60.61
|
| Rate for Payer: Blue Shield of California EPN |
$48.03
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Cigna of CA HMO |
$57.57
|
| Rate for Payer: Cigna of CA PPO |
$57.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.90
|
| Rate for Payer: Dignity Health Media |
$69.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.90
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Multiplan Commercial |
$65.79
|
| Rate for Payer: Networks By Design Commercial |
$53.46
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.12
|
| Rate for Payer: United Healthcare All Other HMO |
$41.12
|
| Rate for Payer: United Healthcare HMO Rider |
$41.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.90
|
| Rate for Payer: Vantage Medical Group Senior |
$69.90
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$19.24
|
|
|
Service Code
|
NDC 0527-2133-35
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Blue Shield of California Commercial |
$13.70
|
| Rate for Payer: Blue Shield of California EPN |
$9.85
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cigna of CA HMO |
$13.47
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.70
|
| Rate for Payer: Galaxy Health WC |
$16.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$15.39
|
| Rate for Payer: Networks By Design Commercial |
$12.51
|
| Rate for Payer: Prime Health Services Commercial |
$16.35
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [77371]
|
Facility
|
OP
|
$16.45
|
|
|
Service Code
|
NDC 0085-1328-01
|
| Hospital Charge Code |
1715196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$13.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.80
|
| Rate for Payer: Blue Distinction Transplant |
$9.87
|
| Rate for Payer: Blue Shield of California Commercial |
$12.12
|
| Rate for Payer: Blue Shield of California EPN |
$9.61
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$11.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.98
|
| Rate for Payer: Dignity Health Media |
$13.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.58
|
| Rate for Payer: Galaxy Health WC |
$13.98
|
| Rate for Payer: Global Benefits Group Commercial |
$9.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$10.69
|
| Rate for Payer: Prime Health Services Commercial |
$13.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13.98
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [77371]
|
Facility
|
IP
|
$16.45
|
|
|
Service Code
|
NDC 0085-1328-01
|
| Hospital Charge Code |
1715196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$13.98 |
| Rate for Payer: Blue Shield of California Commercial |
$11.71
|
| Rate for Payer: Blue Shield of California EPN |
$8.42
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: Galaxy Health WC |
$13.98
|
| Rate for Payer: Global Benefits Group Commercial |
$9.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$10.69
|
| Rate for Payer: Prime Health Services Commercial |
$13.98
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
OP
|
$38.12
|
|
|
Service Code
|
NDC 0085-4331-01
|
| Hospital Charge Code |
NDG2211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.71
|
| Rate for Payer: Blue Distinction Transplant |
$22.87
|
| Rate for Payer: Blue Shield of California Commercial |
$28.09
|
| Rate for Payer: Blue Shield of California EPN |
$22.26
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.40
|
| Rate for Payer: Dignity Health Media |
$32.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.06
|
| Rate for Payer: United Healthcare All Other HMO |
$19.06
|
| Rate for Payer: United Healthcare HMO Rider |
$19.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.40
|
| Rate for Payer: Vantage Medical Group Senior |
$32.40
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
IP
|
$38.12
|
|
|
Service Code
|
NDC 0085-4331-01
|
| Hospital Charge Code |
NDG2211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Blue Shield of California Commercial |
$27.14
|
| Rate for Payer: Blue Shield of California EPN |
$19.52
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.40
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$35,350.37
|
|
|
Service Code
|
APR-DRG 7113
|
| Min. Negotiated Rate |
$27,117.46 |
| Max. Negotiated Rate |
$35,350.37 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,117.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,350.37
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$66,382.39
|
|
|
Service Code
|
APR-DRG 7114
|
| Min. Negotiated Rate |
$50,922.28 |
| Max. Negotiated Rate |
$66,382.39 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50,922.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66,382.39
|
|
