|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [9409]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 5022846101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [9409]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 5022846101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
CARBIDOPA ER 61.25 MG-LEVODOPA 245 MG CAPSULE,EXTENDED RELEASE [208776]
|
Facility
|
OP
|
$6.26
|
|
|
Service Code
|
NDC 6489666401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.63 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$2.50
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Central Health Plan Commercial |
$5.01
|
| Rate for Payer: Cigna of CA HMO |
$4.38
|
| Rate for Payer: Cigna of CA PPO |
$4.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$4.07
|
| Rate for Payer: Prime Health Services Commercial |
$5.32
|
| Rate for Payer: Riverside University Health System MISP |
$2.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.13
|
| Rate for Payer: United Healthcare All Other HMO |
$3.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
CARBIDOPA ER 61.25 MG-LEVODOPA 245 MG CAPSULE,EXTENDED RELEASE [208776]
|
Facility
|
IP
|
$6.26
|
|
|
Service Code
|
NDC 6489666401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.63 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$5.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.16
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Central Health Plan Commercial |
$5.01
|
| Rate for Payer: Cigna of CA HMO |
$4.38
|
| Rate for Payer: Cigna of CA PPO |
$4.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$4.07
|
| Rate for Payer: Prime Health Services Commercial |
$5.32
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$294.54 |
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$3.91
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$1.85
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$3.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.13
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Prime Health Services Commercial |
$3.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Riverside University Health System MISP |
$0.87
|
| Rate for Payer: Riverside University Health System MISP |
$0.69
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| Rate for Payer: Riverside University Health System MISP |
$1.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.59
|
| Rate for Payer: Riverside University Health System MISP |
$0.87
|
| Rate for Payer: Riverside University Health System MISP |
$2.23
|
| Rate for Payer: Riverside University Health System MISP |
$1.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.47
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Adventist Health Commercial |
$0.75
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Central Health Plan Commercial |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$2.64
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA HMO |
$3.91
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$2.64
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$3.02
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Galaxy Health WC |
$1.85
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$2.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: Networks By Design Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$3.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS J0675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Blue Shield of California Commercial |
$57.74
|
| Rate for Payer: Blue Shield of California Commercial |
$307.00
|
| Rate for Payer: Blue Shield of California EPN |
$192.93
|
| Rate for Payer: Blue Shield of California EPN |
$36.29
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: Cigna of CA HMO |
$267.95
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$267.95
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$191.40
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare All Other HMO |
$139.83
|
| Rate for Payer: United Healthcare HMO Rider |
$136.81
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
OP
|
$382.79
|
|
|
Service Code
|
HCPCS J0675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.37
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.37
|
| Rate for Payer: Blue Shield of California Commercial |
$45.65
|
| Rate for Payer: Blue Shield of California Commercial |
$242.69
|
| Rate for Payer: Blue Shield of California EPN |
$152.73
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$267.95
|
| Rate for Payer: Cigna of CA HMO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$50.40
|
| Rate for Payer: Cigna of CA PPO |
$267.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.01
|
| Rate for Payer: EPIC Health Plan Senior |
$18.01
|
| Rate for Payer: EPIC Health Plan Senior |
$18.01
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.94
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$191.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.37
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
| Rate for Payer: Prime Health Services Medicare |
$17.35
|
| Rate for Payer: Prime Health Services Medicare |
$17.35
|
| Rate for Payer: Riverside University Health System MISP |
$18.01
|
| Rate for Payer: Riverside University Health System MISP |
$18.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.02
|
| Rate for Payer: United Healthcare All Other HMO |
$139.83
|
| Rate for Payer: United Healthcare All Other HMO |
$26.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.73
|
| Rate for Payer: United Healthcare HMO Rider |
$136.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.01
|
| Rate for Payer: Vantage Medical Group Senior |
$16.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16.37
|
|
|
CARBOXYMETHYL 0.5 %-GLYCERIN 1 %-POLYSORB 80 0.5 %-PF EYE DROPPERETTE [201979]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 0023449130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Riverside University Health System MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
CARBOXYMETHYL 0.5 %-GLYCERIN 1 %-POLYSORB 80 0.5 %-PF EYE DROPPERETTE [201979]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 0023449130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 6961807655
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 5026806815
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| 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 |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 5026806815
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| 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 |
$0.48
|
| 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 |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| 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 |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| 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
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 0023079815
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
| Rate for Payer: Riverside University Health System MISP |
$0.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 6961807655
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 0023079815
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 0023040350
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 0023040350
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 0023040330
|
| 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 |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| 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
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 0023040330
|
| 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 |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.16
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE [38321]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 0023455430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| 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 |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE [38321]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 0023455430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS [27992]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 0023920515
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS [27992]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 0023920515
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
|
IP
|
$8,854.38
|
|
|
Service Code
|
APR-DRG 1962
|
| Min. Negotiated Rate |
$5,592.24 |
| Max. Negotiated Rate |
$8,854.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,592.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,664.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,854.38
|
|
