|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.57
|
| Rate for Payer: InnovAge PACE Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Riverside University Health System MISP |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
IP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Riverside University Health System MISP |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
IP
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California Commercial |
$8.19
|
| Rate for Payer: Blue Shield of California EPN |
$5.34
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$8.47
|
| Rate for Payer: Cigna of CA HMO |
$7.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$7.94
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$9.00
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
OP
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6.47
|
| Rate for Payer: Blue Shield of California EPN |
$4.23
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$8.47
|
| Rate for Payer: Cigna of CA HMO |
$7.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.53
|
| Rate for Payer: InnovAge PACE Commercial |
$5.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$7.94
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$9.00
|
| Rate for Payer: Riverside University Health System MISP |
$4.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.29
|
| Rate for Payer: United Healthcare All Other HMO |
$5.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.00
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.51
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
IP
|
$155.90
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$140.31 |
| Rate for Payer: Adventist Health Commercial |
$31.18
|
| Rate for Payer: Blue Shield of California Commercial |
$120.51
|
| Rate for Payer: Blue Shield of California EPN |
$78.57
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Central Health Plan Commercial |
$124.72
|
| Rate for Payer: Cigna of CA HMO |
$109.13
|
| Rate for Payer: Cigna of CA PPO |
$109.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.36
|
| Rate for Payer: EPIC Health Plan Senior |
$62.36
|
| Rate for Payer: Galaxy Health WC |
$132.51
|
| Rate for Payer: Global Benefits Group Commercial |
$93.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.18
|
| Rate for Payer: Multiplan Commercial |
$116.92
|
| Rate for Payer: Networks By Design Commercial |
$101.33
|
| Rate for Payer: Prime Health Services Commercial |
$132.51
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
OP
|
$155.90
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$140.31 |
| Rate for Payer: Adventist Health Commercial |
$31.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.56
|
| Rate for Payer: Blue Shield of California Commercial |
$95.25
|
| Rate for Payer: Blue Shield of California EPN |
$62.20
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Central Health Plan Commercial |
$124.72
|
| Rate for Payer: Cigna of CA HMO |
$109.13
|
| Rate for Payer: Cigna of CA PPO |
$109.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.36
|
| Rate for Payer: EPIC Health Plan Senior |
$62.36
|
| Rate for Payer: Galaxy Health WC |
$132.51
|
| Rate for Payer: Global Benefits Group Commercial |
$93.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.31
|
| Rate for Payer: InnovAge PACE Commercial |
$77.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.13
|
| Rate for Payer: Multiplan Commercial |
$116.92
|
| Rate for Payer: Networks By Design Commercial |
$101.33
|
| Rate for Payer: Prime Health Services Commercial |
$132.51
|
| Rate for Payer: Riverside University Health System MISP |
$62.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.95
|
| Rate for Payer: United Healthcare All Other HMO |
$77.95
|
| Rate for Payer: United Healthcare HMO Rider |
$77.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.51
|
| Rate for Payer: Vantage Medical Group Senior |
$132.51
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.80
|
| Rate for Payer: Cigna of CA PPO |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: InnovAge PACE Commercial |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Riverside University Health System MISP |
$1.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.40
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$314.94 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Blue Shield of California Commercial |
$270.50
|
| Rate for Payer: Blue Shield of California EPN |
$176.36
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Central Health Plan Commercial |
$279.94
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$314.94 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.51
|
| Rate for Payer: Blue Shield of California Commercial |
$213.81
|
| Rate for Payer: Blue Shield of California EPN |
$139.62
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Central Health Plan Commercial |
$279.94
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.94
|
| Rate for Payer: InnovAge PACE Commercial |
$174.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
| Rate for Payer: Riverside University Health System MISP |
$139.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.97
|
| Rate for Payer: United Healthcare All Other HMO |
$174.97
|
| Rate for Payer: United Healthcare HMO Rider |
$174.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.44
|
| Rate for Payer: Vantage Medical Group Senior |
$297.44
|
|
|
ABEMACICLIB 150 MG TABLET [219900]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-5337-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$314.94 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.51
|
| Rate for Payer: Blue Shield of California Commercial |
$213.81
|
| Rate for Payer: Blue Shield of California EPN |
$139.62
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Central Health Plan Commercial |
$279.94
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.94
|
| Rate for Payer: InnovAge PACE Commercial |
$174.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
| Rate for Payer: Riverside University Health System MISP |
$139.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.97
|
| Rate for Payer: United Healthcare All Other HMO |
$174.97
|
| Rate for Payer: United Healthcare HMO Rider |
$174.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.44
|
| Rate for Payer: Vantage Medical Group Senior |
$297.44
|
|
|
ABEMACICLIB 150 MG TABLET [219900]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-5337-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$314.94 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Blue Shield of California Commercial |
$270.50
|
| Rate for Payer: Blue Shield of California EPN |
$176.36
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Central Health Plan Commercial |
$279.94
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-6216-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$314.94 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Blue Shield of California Commercial |
$270.50
|
| Rate for Payer: Blue Shield of California EPN |
$176.36
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Central Health Plan Commercial |
$279.94
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-6216-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$314.94 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.51
|
| Rate for Payer: Blue Shield of California Commercial |
$213.81
|
| Rate for Payer: Blue Shield of California EPN |
$139.62
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Central Health Plan Commercial |
$279.94
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.94
|
| Rate for Payer: InnovAge PACE Commercial |
$174.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
| Rate for Payer: Riverside University Health System MISP |
$139.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.97
|
| Rate for Payer: United Healthcare All Other HMO |
$174.97
|
| Rate for Payer: United Healthcare HMO Rider |
$174.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.44
|
| Rate for Payer: Vantage Medical Group Senior |
$297.44
|
|
|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$314.94 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Blue Shield of California Commercial |
$270.50
|
| Rate for Payer: Blue Shield of California EPN |
$176.36
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Central Health Plan Commercial |
$279.94
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
|
|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$314.94 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.51
|
| Rate for Payer: Blue Shield of California Commercial |
$213.81
|
| Rate for Payer: Blue Shield of California EPN |
$139.62
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Central Health Plan Commercial |
$279.94
|
| Rate for Payer: Cigna of CA HMO |
$244.95
|
| Rate for Payer: Cigna of CA PPO |
$244.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: EPIC Health Plan Senior |
$139.97
|
| Rate for Payer: Galaxy Health WC |
$297.44
|
| Rate for Payer: Global Benefits Group Commercial |
$209.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$314.94
|
| Rate for Payer: InnovAge PACE Commercial |
$174.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: Networks By Design Commercial |
$227.45
|
| Rate for Payer: Prime Health Services Commercial |
$297.44
|
| Rate for Payer: Riverside University Health System MISP |
$139.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.97
|
| Rate for Payer: United Healthcare All Other HMO |
$174.97
|
| Rate for Payer: United Healthcare HMO Rider |
$174.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.44
|
| Rate for Payer: Vantage Medical Group Senior |
$297.44
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
|
OP
|
$119.69
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$107.72 |
| Rate for Payer: Adventist Health Commercial |
$23.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.29
|
| Rate for Payer: Blue Shield of California Commercial |
$73.13
|
| Rate for Payer: Blue Shield of California EPN |
$47.76
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Central Health Plan Commercial |
$95.75
|
| Rate for Payer: Cigna of CA HMO |
$83.78
|
| Rate for Payer: Cigna of CA PPO |
$83.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.88
|
| Rate for Payer: EPIC Health Plan Senior |
$47.88
|
| Rate for Payer: Galaxy Health WC |
$101.74
|
| Rate for Payer: Global Benefits Group Commercial |
$71.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.72
|
| Rate for Payer: InnovAge PACE Commercial |
$59.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.78
|
| Rate for Payer: Multiplan Commercial |
$89.77
|
| Rate for Payer: Networks By Design Commercial |
$77.80
|
| Rate for Payer: Prime Health Services Commercial |
$101.74
|
| Rate for Payer: Riverside University Health System MISP |
$47.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.84
|
| Rate for Payer: United Healthcare All Other HMO |
$59.84
|
| Rate for Payer: United Healthcare HMO Rider |
$59.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.74
|
| Rate for Payer: Vantage Medical Group Senior |
$101.74
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
|
IP
|
$119.69
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$107.72 |
| Rate for Payer: Adventist Health Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California Commercial |
$92.52
|
| Rate for Payer: Blue Shield of California EPN |
$60.32
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Central Health Plan Commercial |
$95.75
|
| Rate for Payer: Cigna of CA HMO |
$83.78
|
| Rate for Payer: Cigna of CA PPO |
$83.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.88
|
| Rate for Payer: EPIC Health Plan Senior |
$47.88
|
| Rate for Payer: Galaxy Health WC |
$101.74
|
| Rate for Payer: Global Benefits Group Commercial |
$71.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.94
|
| Rate for Payer: Multiplan Commercial |
$89.77
|
| Rate for Payer: Networks By Design Commercial |
$77.80
|
| Rate for Payer: Prime Health Services Commercial |
$101.74
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
OP
|
$634.20
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$570.78 |
| Rate for Payer: Adventist Health Commercial |
$126.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$385.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.94
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Cash Price |
$348.81
|
| Rate for Payer: Cash Price |
$348.81
|
| Rate for Payer: Central Health Plan Commercial |
$507.36
|
| Rate for Payer: Cigna of CA HMO |
$443.94
|
| Rate for Payer: Cigna of CA PPO |
$443.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.17
|
| Rate for Payer: Galaxy Health WC |
$539.07
|
| Rate for Payer: Global Benefits Group Commercial |
$380.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.17
|
| Rate for Payer: InnovAge PACE Commercial |
$13.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$475.65
|
| Rate for Payer: Networks By Design Commercial |
$317.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.17
|
| Rate for Payer: Prime Health Services Commercial |
$539.07
|
| Rate for Payer: Prime Health Services Medicare |
$9.72
|
| Rate for Payer: Riverside University Health System MISP |
$10.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.02
|
| Rate for Payer: United Healthcare All Other HMO |
$231.67
|
| Rate for Payer: United Healthcare HMO Rider |
$226.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.09
|
| Rate for Payer: Vantage Medical Group Senior |
$10.09
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
IP
|
$634.20
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.84 |
| Max. Negotiated Rate |
$570.78 |
| Rate for Payer: Adventist Health Commercial |
$126.84
|
| Rate for Payer: Blue Shield of California Commercial |
$490.24
|
| Rate for Payer: Blue Shield of California EPN |
$319.64
|
| Rate for Payer: Cash Price |
$348.81
|
| Rate for Payer: Central Health Plan Commercial |
$507.36
|
| Rate for Payer: Cigna of CA HMO |
$443.94
|
| Rate for Payer: Cigna of CA PPO |
$443.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.68
|
| Rate for Payer: EPIC Health Plan Senior |
$253.68
|
| Rate for Payer: Galaxy Health WC |
$539.07
|
| Rate for Payer: Global Benefits Group Commercial |
$380.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.84
|
| Rate for Payer: Multiplan Commercial |
$475.65
|
| Rate for Payer: Networks By Design Commercial |
$317.10
|
| Rate for Payer: Prime Health Services Commercial |
$539.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.02
|
| Rate for Payer: United Healthcare All Other HMO |
$231.67
|
| Rate for Payer: United Healthcare HMO Rider |
$226.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.70
|
|
|
ACARBOSE 25 MG TABLET [22148]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 64380-758-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: InnovAge PACE Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ACARBOSE 25 MG TABLET [22148]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 64380-758-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
ACARBOSE 50 MG TABLET [15895]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 0054-0141-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: InnovAge PACE Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
