|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
|
IP
|
$12.23
|
|
|
Service Code
|
NDC 61314-245-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Blue Shield of California Commercial |
$9.45
|
| Rate for Payer: Blue Shield of California EPN |
$6.16
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Central Health Plan Commercial |
$9.78
|
| Rate for Payer: Cigna of CA HMO |
$8.56
|
| Rate for Payer: Cigna of CA PPO |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Senior |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$9.17
|
| Rate for Payer: Networks By Design Commercial |
$7.95
|
| Rate for Payer: Prime Health Services Commercial |
$10.40
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
|
OP
|
$12.23
|
|
|
Service Code
|
NDC 61314-245-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.47
|
| Rate for Payer: Blue Shield of California EPN |
$4.88
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Central Health Plan Commercial |
$9.78
|
| Rate for Payer: Cigna of CA HMO |
$8.56
|
| Rate for Payer: Cigna of CA PPO |
$8.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Senior |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.01
|
| Rate for Payer: InnovAge PACE Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.56
|
| Rate for Payer: Multiplan Commercial |
$9.17
|
| Rate for Payer: Networks By Design Commercial |
$7.95
|
| Rate for Payer: Prime Health Services Commercial |
$10.40
|
| Rate for Payer: Riverside University Health System MISP |
$4.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO |
$6.12
|
| Rate for Payer: United Healthcare HMO Rider |
$6.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10.40
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 0832-0511-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: InnovAge PACE Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: Riverside University Health System MISP |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 0832-0511-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
IP
|
$0.76
|
|
|
Service Code
|
NDC 0832-0511-89
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 0832-0511-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| 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 |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: InnovAge PACE Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Riverside University Health System MISP |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 0832-0511-89
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: InnovAge PACE Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: Riverside University Health System MISP |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
IP
|
$0.76
|
|
|
Service Code
|
NDC 0832-0511-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
NDC 60687-700-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
NDC 60687-700-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
NDC 60687-700-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.00
|
| Rate for Payer: InnovAge PACE Commercial |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
NDC 60687-700-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.00
|
| Rate for Payer: InnovAge PACE Commercial |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
BETHANECHOL CHLORIDE 5 MG TABLET [1045]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 0832-0510-00
|
| 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 |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.16
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.18
|
| 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
|
|
|
BETHANECHOL CHLORIDE 5 MG TABLET [1045]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 0832-0510-00
|
| 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 |
$0.16
|
| 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: 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: InnovAge PACE Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0802-48
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0802-48
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$73.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$175.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.78
|
| Rate for Payer: Blue Shield of California Commercial |
$105.19
|
| Rate for Payer: Blue Shield of California EPN |
$95.63
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.62
|
| Rate for Payer: EPIC Health Plan Senior |
$73.05
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$119.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.05
|
| Rate for Payer: InnovAge PACE Commercial |
$109.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97.89
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$73.05
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: Prime Health Services Medicare |
$77.43
|
| Rate for Payer: Riverside University Health System MISP |
$80.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.35
|
| Rate for Payer: Vantage Medical Group Senior |
$80.35
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Blue Shield of California Commercial |
$184.81
|
| Rate for Payer: Blue Shield of California EPN |
$120.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Senior |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Blue Shield of California Commercial |
$184.81
|
| Rate for Payer: Blue Shield of California EPN |
$120.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Senior |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$73.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$175.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.78
|
| Rate for Payer: Blue Shield of California Commercial |
$105.19
|
| Rate for Payer: Blue Shield of California EPN |
$95.63
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.62
|
| Rate for Payer: EPIC Health Plan Senior |
$73.05
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$119.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.05
|
| Rate for Payer: InnovAge PACE Commercial |
$109.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97.89
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$73.05
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: Prime Health Services Medicare |
$77.43
|
| Rate for Payer: Riverside University Health System MISP |
$80.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.35
|
| Rate for Payer: Vantage Medical Group Senior |
$80.35
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
NDC 9994-0810-93
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.41
|
| Rate for Payer: Blue Shield of California Commercial |
$146.08
|
| Rate for Payer: Blue Shield of California EPN |
$95.39
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$153.01
|
| Rate for Payer: Cigna of CA PPO |
$176.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$203.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Senior |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: InnovAge PACE Commercial |
$119.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$167.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167.36
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$155.40
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: Riverside University Health System MISP |
$95.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.54
|
| Rate for Payer: United Healthcare All Other HMO |
$119.54
|
| Rate for Payer: United Healthcare HMO Rider |
$119.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.22
|
| Rate for Payer: Vantage Medical Group Senior |
$203.22
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
NDC 9994-0810-93
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Blue Shield of California Commercial |
$184.81
|
| Rate for Payer: Blue Shield of California EPN |
$120.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Senior |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$155.40
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
OP
|
$209.32
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.85 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Adventist Health Commercial |
$41.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$28.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$153.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.09
|
| Rate for Payer: Blue Shield of California Commercial |
$92.10
|
| Rate for Payer: Blue Shield of California EPN |
$83.73
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cash Price |
$115.13
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cash Price |
$115.13
|
| Rate for Payer: Central Health Plan Commercial |
$167.46
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$28.85
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$188.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$47.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28.85
|
| Rate for Payer: InnovAge PACE Commercial |
$43.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.66
|
| Rate for Payer: Multiplan Commercial |
$156.99
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28.85
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: Prime Health Services Medicare |
$30.58
|
| Rate for Payer: Riverside University Health System MISP |
$31.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$125.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$125.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.56
|
| Rate for Payer: United Healthcare All Other HMO |
$76.46
|
| Rate for Payer: United Healthcare HMO Rider |
$74.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$28.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.73
|
| Rate for Payer: Vantage Medical Group Senior |
$31.73
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
IP
|
$209.32
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Adventist Health Commercial |
$41.86
|
| Rate for Payer: Blue Shield of California Commercial |
$161.80
|
| Rate for Payer: Blue Shield of California EPN |
$105.50
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cash Price |
$115.13
|
| Rate for Payer: Central Health Plan Commercial |
$167.46
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Senior |
$83.73
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$188.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.86
|
| Rate for Payer: Multiplan Commercial |
$156.99
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.56
|
| Rate for Payer: United Healthcare All Other HMO |
$76.46
|
| Rate for Payer: United Healthcare HMO Rider |
$74.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.55
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [216412]
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$39.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.65
|
| Rate for Payer: Blue Shield of California Commercial |
$50.16
|
| Rate for Payer: Blue Shield of California EPN |
$45.60
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$79.80
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.76
|
| Rate for Payer: EPIC Health Plan Senior |
$39.83
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$65.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.83
|
| Rate for Payer: InnovAge PACE Commercial |
$59.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.37
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$57.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$39.83
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Prime Health Services Medicare |
$42.21
|
| Rate for Payer: Riverside University Health System MISP |
$43.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.78
|
| Rate for Payer: United Healthcare All Other HMO |
$41.64
|
| Rate for Payer: United Healthcare HMO Rider |
$40.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$39.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.81
|
| Rate for Payer: Vantage Medical Group Senior |
$43.81
|
|
