|
CARBIDOPA ER 61.25 MG-LEVODOPA 245 MG CAPSULE,EXTENDED RELEASE [208776]
|
Facility
IP
|
$6.27
|
|
|
Service Code
|
NDC 64896-664-01
|
| Hospital Charge Code |
ERX208776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.70
|
| Rate for Payer: Blue Shield of California EPN |
$3.35
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.39
|
| Rate for Payer: Cigna of CA PPO |
$4.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.33
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.18
|
| 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 |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.33
|
|
|
CARBIDOPA ER 61.25 MG-LEVODOPA 245 MG CAPSULE,EXTENDED RELEASE [208776]
|
Facility
OP
|
$6.27
|
|
|
Service Code
|
NDC 64896-664-01
|
| Hospital Charge Code |
ERX208776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.70
|
| Rate for Payer: BCBS Transplant Transplant |
$3.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.39
|
| Rate for Payer: Cigna of CA PPO |
$4.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.33
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.70
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.18
|
| 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 |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.76
|
| Rate for Payer: Riverside University Health MISP |
$2.51
|
| 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 |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.33
|
| Rate for Payer: Vantage Medical Group Senior |
$5.33
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
1755740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$258.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| 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 |
$258.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.42
|
| Rate for Payer: BCBS Transplant Transplant |
$0.68
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$8.28
|
| Rate for Payer: Blue Shield of California EPN |
$8.28
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Central Health Plan Commercial |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: IEHP medi-cal |
$3.69
|
| Rate for Payer: IEHP medi-cal |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Riverside University Health MISP |
$0.80
|
| Rate for Payer: Riverside University Health MISP |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Vantage Medical Group Senior |
$0.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
OP
|
$2.17
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
1755737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$258.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.42
|
| Rate for Payer: BCBS Transplant Transplant |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$8.28
|
| 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: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.63
|
| Rate for Payer: IEHP medi-cal |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Riverside University Health MISP |
$0.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
1755740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Central Health Plan Commercial |
$0.91
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
IP
|
$2.17
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
1755737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| 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: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
OP
|
$2.18
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
NDG39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$258.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.42
|
| Rate for Payer: BCBS Transplant Transplant |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$8.28
|
| 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: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.64
|
| Rate for Payer: IEHP medi-cal |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.85
|
| Rate for Payer: Riverside University Health MISP |
$0.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.09
|
| Rate for Payer: United Healthcare HMO Rider |
$1.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1.85
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
IP
|
$2.18
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
NDG39265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| 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: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.85
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
OP
|
$1.18
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
1755491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$258.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.42
|
| Rate for Payer: BCBS Transplant Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$8.28
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.89
|
| Rate for Payer: IEHP medi-cal |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: Riverside University Health MISP |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
1755491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-5
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$150.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.93
|
| Rate for Payer: BCBS Transplant Transplant |
$106.56
|
| Rate for Payer: Blue Shield of California Commercial |
$111.71
|
| Rate for Payer: Blue Shield of California EPN |
$86.85
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: Cigna of CA HMO |
$113.66
|
| Rate for Payer: Cigna of CA PPO |
$131.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$133.20
|
| Rate for Payer: IEHP medi-cal |
$62.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: Riverside University Health MISP |
$71.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.80
|
| Rate for Payer: United Healthcare All Other HMO |
$88.80
|
| Rate for Payer: United Healthcare HMO Rider |
$88.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.96
|
| Rate for Payer: Vantage Medical Group Senior |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
IP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-1
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$133.20
|
| Rate for Payer: Blue Shield of California EPN |
$94.84
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
IP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-5
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$133.20
|
| Rate for Payer: Blue Shield of California EPN |
$94.84
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-1
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$150.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.93
|
| Rate for Payer: BCBS Transplant Transplant |
$106.56
|
| Rate for Payer: Blue Shield of California Commercial |
$111.71
|
| Rate for Payer: Blue Shield of California EPN |
$86.85
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: Cigna of CA HMO |
$113.66
|
| Rate for Payer: Cigna of CA PPO |
$131.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$133.20
|
| Rate for Payer: IEHP medi-cal |
$62.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: Riverside University Health MISP |
$71.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.80
|
| Rate for Payer: United Healthcare All Other HMO |
$88.80
|
| Rate for Payer: United Healthcare HMO Rider |
$88.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.96
|
| Rate for Payer: Vantage Medical Group Senior |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-58
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$232.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$325.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$210.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$210.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.15
|
| Rate for Payer: BCBS Transplant Transplant |
$229.67
|
| Rate for Payer: Blue Shield of California Commercial |
$240.77
|
| Rate for Payer: Blue Shield of California EPN |
$187.18
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$287.09
|
| Rate for Payer: IEHP medi-cal |
$133.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
| Rate for Payer: Riverside University Health MISP |
$153.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Vantage Medical Group Senior |
$325.37
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-3
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$150.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.93
|
| Rate for Payer: BCBS Transplant Transplant |
$106.56
|
| Rate for Payer: Blue Shield of California Commercial |
$111.71
|
| Rate for Payer: Blue Shield of California EPN |
$86.85
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: Cigna of CA HMO |
$113.66
|
| Rate for Payer: Cigna of CA PPO |
$131.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$133.20
|
| Rate for Payer: IEHP medi-cal |
$62.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: Riverside University Health MISP |
$71.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.80
|
| Rate for Payer: United Healthcare All Other HMO |
$88.80
|
| Rate for Payer: United Healthcare HMO Rider |
$88.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.96
|
| Rate for Payer: Vantage Medical Group Senior |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-11
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$232.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$325.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$210.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$210.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.15
|
| Rate for Payer: BCBS Transplant Transplant |
$229.67
|
| Rate for Payer: Blue Shield of California Commercial |
$240.77
|
| Rate for Payer: Blue Shield of California EPN |
$187.18
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$287.09
|
| Rate for Payer: IEHP medi-cal |
$133.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
| Rate for Payer: Riverside University Health MISP |
$153.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Vantage Medical Group Senior |
$325.37
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
IP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-11
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$287.09
|
| Rate for Payer: Blue Shield of California EPN |
$204.41
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
IP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-3
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$133.20
|
| Rate for Payer: Blue Shield of California EPN |
$94.84
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
IP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-58
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$287.09
|
| Rate for Payer: Blue Shield of California EPN |
$204.41
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
|
|
CARBOXYMETHYL 0.5 %-GLYCERIN 1 %-POLYSORB 80 0.5 %-PF EYE DROPPERETTE [201979]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 0023-4491-30
|
| Hospital Charge Code |
ERX201979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.32
|
| 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
|
|
|
CARBOXYMETHYL 0.5 %-GLYCERIN 1 %-POLYSORB 80 0.5 %-PF EYE DROPPERETTE [201979]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 0023-4491-30
|
| Hospital Charge Code |
ERX201979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| 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: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| 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: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
NDC 50268-068-15
|
| Hospital Charge Code |
1740385
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
OP
|
$0.67
|
|
|
Service Code
|
NDC 0023-0798-15
|
| Hospital Charge Code |
1740385
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| 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: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: IEHP medi-cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
IP
|
$0.67
|
|
|
Service Code
|
NDC 0023-0798-15
|
| Hospital Charge Code |
1740385
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.30
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.45
|
| 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
|
|
