|
1-stage distal hypospadias repair (with or without chordee or circumcision); with simple meatal advancement (eg, Magpi, V-flap)
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 54322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (eg, flip-flap, prepucial flap)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 54324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
1-stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 54332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
IP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
NDG24439
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.28
|
| 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: 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: 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 20 MG/ML ORAL SOLUTION [24439]
|
Facility
OP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
NDG24439
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| 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: BCBS Transplant Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.28
|
| 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: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.47
|
| Rate for Payer: IEHP medi-cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
1710876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| 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: 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: 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 300 MG TABLET [24438]
|
Facility
OP
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
1710876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: IEHP medi-cal |
$3.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.26
|
| Rate for Payer: BCBS Transplant Transplant |
$6.35
|
| Rate for Payer: Blue Shield of California Commercial |
$6.66
|
| Rate for Payer: Blue Shield of California EPN |
$5.18
|
| Rate for Payer: Cash Price |
$4.77
|
| 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: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$7.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.06
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.35
|
| Rate for Payer: Riverside University Health 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 |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO |
$5.30
|
| Rate for Payer: United Healthcare HMO Rider |
$5.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.30
|
| 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
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
1710876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.94
|
| Rate for Payer: Blue Shield of California EPN |
$5.66
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cash Price |
$4.77
|
| 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: 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: 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
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
1710876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.77
|
| Rate for Payer: BCBS Transplant Transplant |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$1.35
|
| 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: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2.25
|
| Rate for Payer: IEHP medi-cal |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
IP
|
$141.50
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
ERX207101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.30 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$106.12
|
| Rate for Payer: Blue Shield of California EPN |
$75.56
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Central Health Plan Commercial |
$113.20
|
| Rate for Payer: Cigna of CA HMO |
$99.05
|
| Rate for Payer: Cigna of CA PPO |
$99.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.60
|
| Rate for Payer: Galaxy Health WC |
$120.28
|
| Rate for Payer: Global Benefits Group Commercial |
$84.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.30
|
| Rate for Payer: Multiplan Commercial |
$106.12
|
| Rate for Payer: Networks By Design Commercial |
$91.98
|
| Rate for Payer: Prime Health Services Commercial |
$120.28
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
OP
|
$141.50
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
ERX207101
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.30 |
| Max. Negotiated Rate |
$127.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.60
|
| Rate for Payer: BCBS Transplant Transplant |
$84.90
|
| Rate for Payer: Blue Shield of California Commercial |
$89.00
|
| Rate for Payer: Blue Shield of California EPN |
$69.19
|
| Rate for Payer: Cash Price |
$63.68
|
| Rate for Payer: Central Health Plan Commercial |
$113.20
|
| Rate for Payer: Cigna of CA HMO |
$99.05
|
| Rate for Payer: Cigna of CA PPO |
$99.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.60
|
| Rate for Payer: Galaxy Health WC |
$120.28
|
| Rate for Payer: Global Benefits Group Commercial |
$84.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$106.12
|
| Rate for Payer: IEHP medi-cal |
$49.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.30
|
| Rate for Payer: Multiplan Commercial |
$106.12
|
| Rate for Payer: Networks By Design Commercial |
$91.98
|
| Rate for Payer: Prime Health Services Commercial |
$120.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$84.90
|
| Rate for Payer: Riverside University Health MISP |
$56.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.75
|
| Rate for Payer: United Healthcare All Other HMO |
$70.75
|
| Rate for Payer: United Healthcare HMO Rider |
$70.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.28
|
| Rate for Payer: Vantage Medical Group Senior |
$120.28
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
OP
|
$4.00
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
1711932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: BCBS Transplant Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$1.80
|
| 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: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3.00
|
| Rate for Payer: IEHP medi-cal |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$3.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.40
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
IP
|
$4.00
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
1711932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| 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: 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: 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
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [70287]
|
Facility
IP
|
$1,655.88
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
1720952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$331.18 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.91
|
| Rate for Payer: Blue Shield of California EPN |
$884.24
|
| Rate for Payer: Cash Price |
$745.15
|
| Rate for Payer: Cash Price |
$745.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,324.70
|
| Rate for Payer: Cigna of CA HMO |
$1,159.12
|
| Rate for Payer: Cigna of CA PPO |
$1,159.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$662.35
|
| Rate for Payer: Galaxy Health WC |
$1,407.50
|
| Rate for Payer: Global Benefits Group Commercial |
$993.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,490.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,104.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.18
|
| Rate for Payer: Multiplan Commercial |
$1,241.91
|
| Rate for Payer: Networks By Design Commercial |
$827.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.50
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [70287]
|
Facility
OP
|
$1,655.88
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
1720952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$1,490.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$43.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.73
|
| Rate for Payer: BCBS Transplant Transplant |
$993.53
|
| Rate for Payer: Blue Shield of California Commercial |
$62.07
|
| Rate for Payer: Blue Shield of California EPN |
$56.43
|
| Rate for Payer: Caremore Medicare Advantage |
$43.16
|
| Rate for Payer: Cash Price |
$745.15
|
| Rate for Payer: Cash Price |
$745.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,324.70
|
| Rate for Payer: Cigna of CA HMO |
$1,159.12
|
| Rate for Payer: Cigna of CA PPO |
$1,159.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$43.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.16
|
| Rate for Payer: Galaxy Health WC |
$1,407.50
|
| Rate for Payer: Global Benefits Group Commercial |
$993.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,490.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,241.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.79
|
| Rate for Payer: IEHP medi-cal |
$71.22
|
| Rate for Payer: IEHP Medicare Advantage |
$43.16
|
| Rate for Payer: Innovage PACE Commercial |
$64.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,104.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.84
|
| Rate for Payer: Multiplan Commercial |
$1,241.91
|
| Rate for Payer: Networks By Design Commercial |
$827.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.50
|
| Rate for Payer: Prime Health Services Medicare |
$45.75
|
| Rate for Payer: Riverside University Health MISP |
$47.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$993.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$993.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$827.94
|
| Rate for Payer: United Healthcare All Other HMO |
$827.94
|
| Rate for Payer: United Healthcare HMO Rider |
$827.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$827.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.48
|
| Rate for Payer: Vantage Medical Group Senior |
$43.16
|
|
|
ABDOMINAL PAIN
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$7,898.81 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,898.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$9,412.75
|
|
|
ABDOMINAL PAIN
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$4,632.65 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,632.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$5,520.57
|
|
|
ABDOMINAL PAIN
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$5,983.46 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,983.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$7,130.29
|
|
|
ABDOMINAL PAIN
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$13,349.11 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,349.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$15,907.69
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
OP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
ERX219901
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$280.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$189.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$171.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.00
|
| Rate for Payer: BCBS Transplant Transplant |
$186.86
|
| Rate for Payer: Blue Shield of California Commercial |
$195.90
|
| Rate for Payer: Blue Shield of California EPN |
$152.29
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Central Health Plan Commercial |
$249.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$233.58
|
| Rate for Payer: IEHP medi-cal |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: Riverside University Health MISP |
$124.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.72
|
| Rate for Payer: United Healthcare All Other HMO |
$155.72
|
| Rate for Payer: United Healthcare HMO Rider |
$155.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.72
|
| Rate for Payer: Vantage Medical Group Senior |
$264.72
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
IP
|
$311.44
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
ERX219901
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$233.58
|
| Rate for Payer: Blue Shield of California EPN |
$166.31
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Central Health Plan Commercial |
$249.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
|
|
ABEMACICLIB 150 MG TABLET [219900]
|
Facility
OP
|
$311.44
|
|
|
Service Code
|
NDC 0002-5337-54
|
| Hospital Charge Code |
ERX219900
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$280.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$189.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$171.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.00
|
| Rate for Payer: BCBS Transplant Transplant |
$186.86
|
| Rate for Payer: Blue Shield of California Commercial |
$195.90
|
| Rate for Payer: Blue Shield of California EPN |
$152.29
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Central Health Plan Commercial |
$249.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$233.58
|
| Rate for Payer: IEHP medi-cal |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: Riverside University Health MISP |
$124.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.72
|
| Rate for Payer: United Healthcare All Other HMO |
$155.72
|
| Rate for Payer: United Healthcare HMO Rider |
$155.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.72
|
| Rate for Payer: Vantage Medical Group Senior |
$264.72
|
|
|
ABEMACICLIB 150 MG TABLET [219900]
|
Facility
IP
|
$311.44
|
|
|
Service Code
|
NDC 0002-5337-54
|
| Hospital Charge Code |
ERX219900
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$233.58
|
| Rate for Payer: Blue Shield of California EPN |
$166.31
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Central Health Plan Commercial |
$249.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
OP
|
$311.44
|
|
|
Service Code
|
NDC 0002-6216-54
|
| Hospital Charge Code |
ERX219899
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$280.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$189.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$264.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$171.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.00
|
| Rate for Payer: BCBS Transplant Transplant |
$186.86
|
| Rate for Payer: Blue Shield of California Commercial |
$195.90
|
| Rate for Payer: Blue Shield of California EPN |
$152.29
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Central Health Plan Commercial |
$249.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$233.58
|
| Rate for Payer: IEHP medi-cal |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: Riverside University Health MISP |
$124.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.72
|
| Rate for Payer: United Healthcare All Other HMO |
$155.72
|
| Rate for Payer: United Healthcare HMO Rider |
$155.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.72
|
| Rate for Payer: Vantage Medical Group Senior |
$264.72
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
IP
|
$311.44
|
|
|
Service Code
|
NDC 0002-6216-54
|
| Hospital Charge Code |
ERX219899
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$233.58
|
| Rate for Payer: Blue Shield of California EPN |
$166.31
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Cash Price |
$140.15
|
| Rate for Payer: Central Health Plan Commercial |
$249.15
|
| Rate for Payer: Cigna of CA HMO |
$218.01
|
| Rate for Payer: Cigna of CA PPO |
$218.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.58
|
| Rate for Payer: Galaxy Health WC |
$264.72
|
| Rate for Payer: Global Benefits Group Commercial |
$186.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.29
|
| Rate for Payer: Multiplan Commercial |
$233.58
|
| Rate for Payer: Networks By Design Commercial |
$202.44
|
| Rate for Payer: Prime Health Services Commercial |
$264.72
|
|
