|
B-COMPLEX WITH VITAMIN C 1/2 TABLET [408807]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 8068112600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
B-COMPLEX WITH VITAMIN C 1/2 TABLET [408807]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
B-COMPLEX WITH VITAMIN C 1/2 TABLET [408807]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 9999-9998-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 8068112600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 9999-9998-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 8068112600
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0802-47
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0802-47
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BEER [4080757]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 9994-0807-57
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Senior |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: InnovAge PACE Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
BEER [4080757]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
NDC 9994-0807-57
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Senior |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]
|
Facility
|
IP
|
$776.94
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.39 |
| Max. Negotiated Rate |
$699.25 |
| Rate for Payer: Adventist Health Commercial |
$155.39
|
| Rate for Payer: Blue Shield of California Commercial |
$600.57
|
| Rate for Payer: Blue Shield of California EPN |
$391.58
|
| Rate for Payer: Cash Price |
$427.32
|
| Rate for Payer: Central Health Plan Commercial |
$621.55
|
| Rate for Payer: Cigna of CA HMO |
$543.86
|
| Rate for Payer: Cigna of CA PPO |
$543.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.78
|
| Rate for Payer: EPIC Health Plan Senior |
$310.78
|
| Rate for Payer: Galaxy Health WC |
$660.40
|
| Rate for Payer: Global Benefits Group Commercial |
$466.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$699.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.39
|
| Rate for Payer: Multiplan Commercial |
$582.71
|
| Rate for Payer: Networks By Design Commercial |
$388.47
|
| Rate for Payer: Prime Health Services Commercial |
$660.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.59
|
| Rate for Payer: United Healthcare All Other HMO |
$283.82
|
| Rate for Payer: United Healthcare HMO Rider |
$277.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.45
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]
|
Facility
|
OP
|
$776.94
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$699.25 |
| Rate for Payer: Adventist Health Commercial |
$155.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$56.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.70
|
| Rate for Payer: Blue Shield of California Commercial |
$68.45
|
| Rate for Payer: Blue Shield of California EPN |
$62.23
|
| Rate for Payer: Cash Price |
$427.32
|
| Rate for Payer: Cash Price |
$427.32
|
| Rate for Payer: Central Health Plan Commercial |
$621.55
|
| Rate for Payer: Cigna of CA HMO |
$543.86
|
| Rate for Payer: Cigna of CA PPO |
$543.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.61
|
| Rate for Payer: EPIC Health Plan Senior |
$56.01
|
| Rate for Payer: Galaxy Health WC |
$660.40
|
| Rate for Payer: Global Benefits Group Commercial |
$466.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$699.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$91.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56.01
|
| Rate for Payer: InnovAge PACE Commercial |
$84.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.05
|
| Rate for Payer: Multiplan Commercial |
$582.71
|
| Rate for Payer: Networks By Design Commercial |
$388.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$56.01
|
| Rate for Payer: Prime Health Services Commercial |
$660.40
|
| Rate for Payer: Prime Health Services Medicare |
$59.37
|
| Rate for Payer: Riverside University Health System MISP |
$61.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.59
|
| Rate for Payer: United Healthcare All Other HMO |
$283.82
|
| Rate for Payer: United Healthcare HMO Rider |
$277.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$56.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.61
|
| Rate for Payer: Vantage Medical Group Senior |
$61.61
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]
|
Facility
|
IP
|
$26.42
|
|
|
Service Code
|
NDC 0574-7045-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$23.78 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California Commercial |
$20.42
|
| Rate for Payer: Blue Shield of California EPN |
$13.32
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Central Health Plan Commercial |
$21.14
|
| Rate for Payer: Cigna of CA HMO |
$18.49
|
| Rate for Payer: Cigna of CA PPO |
$18.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.57
|
| Rate for Payer: EPIC Health Plan Senior |
$10.57
|
| Rate for Payer: Galaxy Health WC |
$22.46
|
| Rate for Payer: Global Benefits Group Commercial |
$15.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$19.82
|
| Rate for Payer: Networks By Design Commercial |
$17.17
|
| Rate for Payer: Prime Health Services Commercial |
$22.46
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]
|
Facility
|
IP
|
$26.42
|
|
|
Service Code
|
NDC 0574-7045-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$23.78 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California Commercial |
$20.42
|
| Rate for Payer: Blue Shield of California EPN |
$13.32
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Central Health Plan Commercial |
$21.14
|
| Rate for Payer: Cigna of CA HMO |
$18.49
|
| Rate for Payer: Cigna of CA PPO |
$18.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.57
|
| Rate for Payer: EPIC Health Plan Senior |
$10.57
|
| Rate for Payer: Galaxy Health WC |
$22.46
|
| Rate for Payer: Global Benefits Group Commercial |
$15.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$19.82
|
| Rate for Payer: Networks By Design Commercial |
$17.17
|
| Rate for Payer: Prime Health Services Commercial |
$22.46
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]
|
Facility
|
OP
|
$26.42
|
|
|
Service Code
|
NDC 0574-7045-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$23.78 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.52
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Blue Shield of California EPN |
$10.54
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Central Health Plan Commercial |
$21.14
|
| Rate for Payer: Cigna of CA HMO |
$18.49
|
| Rate for Payer: Cigna of CA PPO |
$18.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.57
|
| Rate for Payer: EPIC Health Plan Senior |
$10.57
|
| Rate for Payer: Galaxy Health WC |
$22.46
|
| Rate for Payer: Global Benefits Group Commercial |
$15.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.78
|
| Rate for Payer: InnovAge PACE Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.49
|
| Rate for Payer: Multiplan Commercial |
$19.82
|
| Rate for Payer: Networks By Design Commercial |
$17.17
|
| Rate for Payer: Prime Health Services Commercial |
$22.46
|
| Rate for Payer: Riverside University Health System MISP |
$10.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.21
|
| Rate for Payer: United Healthcare All Other HMO |
$13.21
|
| Rate for Payer: United Healthcare HMO Rider |
$13.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.46
|
| Rate for Payer: Vantage Medical Group Senior |
$22.46
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]
|
Facility
|
OP
|
$26.42
|
|
|
Service Code
|
NDC 0574-7045-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$23.78 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.52
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Blue Shield of California EPN |
$10.54
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Central Health Plan Commercial |
$21.14
|
| Rate for Payer: Cigna of CA HMO |
$18.49
|
| Rate for Payer: Cigna of CA PPO |
$18.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.57
|
| Rate for Payer: EPIC Health Plan Senior |
$10.57
|
| Rate for Payer: Galaxy Health WC |
$22.46
|
| Rate for Payer: Global Benefits Group Commercial |
$15.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.78
|
| Rate for Payer: InnovAge PACE Commercial |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.49
|
| Rate for Payer: Multiplan Commercial |
$19.82
|
| Rate for Payer: Networks By Design Commercial |
$17.17
|
| Rate for Payer: Prime Health Services Commercial |
$22.46
|
| Rate for Payer: Riverside University Health System MISP |
$10.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.21
|
| Rate for Payer: United Healthcare All Other HMO |
$13.21
|
| Rate for Payer: United Healthcare HMO Rider |
$13.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.46
|
| Rate for Payer: Vantage Medical Group Senior |
$22.46
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY [24731]
|
Facility
|
IP
|
$32.11
|
|
|
Service Code
|
NDC 0574-7040-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.42
|
| Rate for Payer: Blue Shield of California Commercial |
$24.82
|
| Rate for Payer: Blue Shield of California EPN |
$16.18
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Central Health Plan Commercial |
$25.69
|
| Rate for Payer: Cigna of CA HMO |
$22.48
|
| Rate for Payer: Cigna of CA PPO |
$22.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.84
|
| Rate for Payer: EPIC Health Plan Senior |
$12.84
|
| Rate for Payer: Galaxy Health WC |
$27.29
|
| Rate for Payer: Global Benefits Group Commercial |
$19.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$24.08
|
| Rate for Payer: Networks By Design Commercial |
$20.87
|
| Rate for Payer: Prime Health Services Commercial |
$27.29
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY [24731]
|
Facility
|
IP
|
$32.11
|
|
|
Service Code
|
NDC 0574-7040-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.42
|
| Rate for Payer: Blue Shield of California Commercial |
$24.82
|
| Rate for Payer: Blue Shield of California EPN |
$16.18
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Central Health Plan Commercial |
$25.69
|
| Rate for Payer: Cigna of CA HMO |
$22.48
|
| Rate for Payer: Cigna of CA PPO |
$22.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.84
|
| Rate for Payer: EPIC Health Plan Senior |
$12.84
|
| Rate for Payer: Galaxy Health WC |
$27.29
|
| Rate for Payer: Global Benefits Group Commercial |
$19.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$24.08
|
| Rate for Payer: Networks By Design Commercial |
$20.87
|
| Rate for Payer: Prime Health Services Commercial |
$27.29
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY [24731]
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 0574-7040-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.86
|
| Rate for Payer: Blue Shield of California Commercial |
$19.62
|
| Rate for Payer: Blue Shield of California EPN |
$12.81
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Central Health Plan Commercial |
$25.69
|
| Rate for Payer: Cigna of CA HMO |
$22.48
|
| Rate for Payer: Cigna of CA PPO |
$22.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.84
|
| Rate for Payer: EPIC Health Plan Senior |
$12.84
|
| Rate for Payer: Galaxy Health WC |
$27.29
|
| Rate for Payer: Global Benefits Group Commercial |
$19.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.90
|
| Rate for Payer: InnovAge PACE Commercial |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.48
|
| Rate for Payer: Multiplan Commercial |
$24.08
|
| Rate for Payer: Networks By Design Commercial |
$20.87
|
| Rate for Payer: Prime Health Services Commercial |
$27.29
|
| Rate for Payer: Riverside University Health System MISP |
$12.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.05
|
| Rate for Payer: United Healthcare All Other HMO |
$16.05
|
| Rate for Payer: United Healthcare HMO Rider |
$16.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.29
|
| Rate for Payer: Vantage Medical Group Senior |
$27.29
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY [24731]
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 0574-7040-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.86
|
| Rate for Payer: Blue Shield of California Commercial |
$19.62
|
| Rate for Payer: Blue Shield of California EPN |
$12.81
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Central Health Plan Commercial |
$25.69
|
| Rate for Payer: Cigna of CA HMO |
$22.48
|
| Rate for Payer: Cigna of CA PPO |
$22.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.84
|
| Rate for Payer: EPIC Health Plan Senior |
$12.84
|
| Rate for Payer: Galaxy Health WC |
$27.29
|
| Rate for Payer: Global Benefits Group Commercial |
$19.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.90
|
| Rate for Payer: InnovAge PACE Commercial |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.48
|
| Rate for Payer: Multiplan Commercial |
$24.08
|
| Rate for Payer: Networks By Design Commercial |
$20.87
|
| Rate for Payer: Prime Health Services Commercial |
$27.29
|
| Rate for Payer: Riverside University Health System MISP |
$12.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.05
|
| Rate for Payer: United Healthcare All Other HMO |
$16.05
|
| Rate for Payer: United Healthcare HMO Rider |
$16.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.29
|
| Rate for Payer: Vantage Medical Group Senior |
$27.29
|
|
|
BENAZEPRIL 10 MG TABLET [9220]
|
Facility
|
IP
|
$0.82
|
|
|
Service Code
|
NDC 50268-110-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Senior |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
|
|
BENAZEPRIL 10 MG TABLET [9220]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 65162-752-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
