|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
OP
|
$595.84
|
|
|
Service Code
|
CPT J9047
|
| Hospital Charge Code |
ERX222456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.08 |
| Max. Negotiated Rate |
$536.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$47.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.83
|
| Rate for Payer: BCBS Transplant Transplant |
$357.50
|
| Rate for Payer: Blue Shield of California Commercial |
$53.58
|
| Rate for Payer: Blue Shield of California EPN |
$48.71
|
| Rate for Payer: Caremore Medicare Advantage |
$47.08
|
| Rate for Payer: Cash Price |
$268.13
|
| Rate for Payer: Cash Price |
$268.13
|
| Rate for Payer: Central Health Plan Commercial |
$476.67
|
| Rate for Payer: Cigna of CA HMO |
$417.09
|
| Rate for Payer: Cigna of CA PPO |
$417.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.08
|
| Rate for Payer: Galaxy Health WC |
$506.46
|
| Rate for Payer: Global Benefits Group Commercial |
$357.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$536.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$446.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.22
|
| Rate for Payer: IEHP medi-cal |
$77.69
|
| Rate for Payer: IEHP Medicare Advantage |
$47.08
|
| Rate for Payer: Innovage PACE Commercial |
$70.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$397.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.09
|
| Rate for Payer: Multiplan Commercial |
$446.88
|
| Rate for Payer: Networks By Design Commercial |
$297.92
|
| Rate for Payer: Prime Health Services Commercial |
$506.46
|
| Rate for Payer: Prime Health Services Medicare |
$49.91
|
| Rate for Payer: Riverside University Health MISP |
$51.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.92
|
| Rate for Payer: United Healthcare All Other HMO |
$297.92
|
| Rate for Payer: United Healthcare HMO Rider |
$297.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.79
|
| Rate for Payer: Vantage Medical Group Senior |
$47.08
|
|
|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]
|
Facility
IP
|
$595.84
|
|
|
Service Code
|
CPT J9047
|
| Hospital Charge Code |
ERX222456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.17 |
| Max. Negotiated Rate |
$536.26 |
| Rate for Payer: Blue Shield of California Commercial |
$446.88
|
| Rate for Payer: Blue Shield of California EPN |
$318.18
|
| Rate for Payer: Cash Price |
$268.13
|
| Rate for Payer: Central Health Plan Commercial |
$476.67
|
| Rate for Payer: Cigna of CA HMO |
$417.09
|
| Rate for Payer: Cigna of CA PPO |
$417.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$238.34
|
| Rate for Payer: Galaxy Health WC |
$506.46
|
| Rate for Payer: Global Benefits Group Commercial |
$357.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$536.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$397.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.17
|
| Rate for Payer: Multiplan Commercial |
$446.88
|
| Rate for Payer: Networks By Design Commercial |
$297.92
|
| Rate for Payer: Prime Health Services Commercial |
$506.46
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
IP
|
$1,787.52
|
|
|
Service Code
|
CPT J9047
|
| Hospital Charge Code |
ERX214890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$357.50 |
| Max. Negotiated Rate |
$1,608.77 |
| Rate for Payer: Blue Shield of California Commercial |
$1,340.64
|
| Rate for Payer: Blue Shield of California EPN |
$954.54
|
| Rate for Payer: Cash Price |
$804.38
|
| Rate for Payer: Central Health Plan Commercial |
$1,430.02
|
| Rate for Payer: Cigna of CA HMO |
$1,251.26
|
| Rate for Payer: Cigna of CA PPO |
$1,251.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$715.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$715.01
|
| Rate for Payer: Galaxy Health WC |
$1,519.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,608.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,192.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.50
|
| Rate for Payer: Multiplan Commercial |
$1,340.64
|
| Rate for Payer: Networks By Design Commercial |
$893.76
|
| Rate for Payer: Prime Health Services Commercial |
$1,519.39
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]
|
Facility
OP
|
$1,787.52
|
|
|
Service Code
|
CPT J9047
|
| Hospital Charge Code |
ERX214890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.08 |
| Max. Negotiated Rate |
$1,608.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$47.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.83
|
| Rate for Payer: BCBS Transplant Transplant |
$1,072.51
|
| Rate for Payer: Blue Shield of California Commercial |
$53.58
|
| Rate for Payer: Blue Shield of California EPN |
$48.71
|
| Rate for Payer: Caremore Medicare Advantage |
$47.08
|
| Rate for Payer: Cash Price |
$804.38
|
| Rate for Payer: Cash Price |
$804.38
|
| Rate for Payer: Central Health Plan Commercial |
$1,430.02
|
| Rate for Payer: Cigna of CA HMO |
$1,251.26
|
| Rate for Payer: Cigna of CA PPO |
$1,251.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.08
|
| Rate for Payer: Galaxy Health WC |
$1,519.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,608.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,340.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.22
|
| Rate for Payer: IEHP medi-cal |
$77.69
|
| Rate for Payer: IEHP Medicare Advantage |
$47.08
|
| Rate for Payer: Innovage PACE Commercial |
$70.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,192.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.09
|
| Rate for Payer: Multiplan Commercial |
$1,340.64
|
| Rate for Payer: Networks By Design Commercial |
$893.76
|
| Rate for Payer: Prime Health Services Commercial |
$1,519.39
|
| Rate for Payer: Prime Health Services Medicare |
$49.91
|
| Rate for Payer: Riverside University Health MISP |
$51.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,072.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,072.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.76
|
| Rate for Payer: United Healthcare All Other HMO |
$893.76
|
| Rate for Payer: United Healthcare HMO Rider |
$893.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$893.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.79
|
| Rate for Payer: Vantage Medical Group Senior |
$47.08
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]
|
Facility
OP
|
$3,575.04
|
|
|
Service Code
|
NDC 76075-101-01
|
| Hospital Charge Code |
1755799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$715.01 |
| Max. Negotiated Rate |
$3,217.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,171.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,966.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,966.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,731.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,112.13
|
| Rate for Payer: BCBS Transplant Transplant |
$2,145.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,248.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,748.19
|
| Rate for Payer: Cash Price |
$1,608.77
|
| Rate for Payer: Cash Price |
$1,608.77
|
| Rate for Payer: Central Health Plan Commercial |
$2,860.03
|
| Rate for Payer: Cigna of CA HMO |
$2,502.53
|
| Rate for Payer: Cigna of CA PPO |
$2,502.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,430.02
|
| Rate for Payer: Galaxy Health WC |
$3,038.78
|
| Rate for Payer: Global Benefits Group Commercial |
$2,145.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,217.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,681.28
|
| Rate for Payer: IEHP medi-cal |
$1,251.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,384.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.01
|
| Rate for Payer: Multiplan Commercial |
$2,681.28
|
| Rate for Payer: Networks By Design Commercial |
$1,787.52
|
| Rate for Payer: Prime Health Services Commercial |
$3,038.78
|
| Rate for Payer: Riverside University Health MISP |
$1,430.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,145.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,145.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,787.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,787.52
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,787.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,038.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3,038.78
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]
|
Facility
IP
|
$3,575.04
|
|
|
Service Code
|
NDC 76075-101-01
|
| Hospital Charge Code |
1755799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$715.01 |
| Max. Negotiated Rate |
$3,217.54 |
| Rate for Payer: Blue Shield of California Commercial |
$2,681.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,909.07
|
| Rate for Payer: Cash Price |
$1,608.77
|
| Rate for Payer: Central Health Plan Commercial |
$2,860.03
|
| Rate for Payer: Cigna of CA HMO |
$2,502.53
|
| Rate for Payer: Cigna of CA PPO |
$2,502.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,430.02
|
| Rate for Payer: Galaxy Health WC |
$3,038.78
|
| Rate for Payer: Global Benefits Group Commercial |
$2,145.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,217.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,384.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.01
|
| Rate for Payer: Multiplan Commercial |
$2,681.28
|
| Rate for Payer: Networks By Design Commercial |
$1,787.52
|
| Rate for Payer: Prime Health Services Commercial |
$3,038.78
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 69584-111-10
|
| Hospital Charge Code |
1711179
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 50228-109-01
|
| Hospital Charge Code |
1711179
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 50228-109-01
|
| Hospital Charge Code |
1711179
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
CARISOPRODOL 350 MG TABLET [1395]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 69584-111-10
|
| Hospital Charge Code |
1711179
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| 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: BCBS Transplant Transplant |
$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 |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CARMUSTINE 100 MG INTRAVENOUS SOLUTION [28911]
|
Facility
IP
|
$900.00
|
|
|
Service Code
|
CPT J9050
|
| Hospital Charge Code |
1755109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Blue Shield of California Commercial |
$675.00
|
| Rate for Payer: Blue Shield of California EPN |
$480.60
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$630.00
|
| Rate for Payer: Cigna of CA PPO |
$630.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$450.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
|
|
CARMUSTINE 100 MG INTRAVENOUS SOLUTION [28911]
|
Facility
OP
|
$900.00
|
|
|
Service Code
|
CPT J9050
|
| Hospital Charge Code |
1755109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$3,481.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$271.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$534.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$339.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$298.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$298.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.99
|
| Rate for Payer: BCBS Transplant Transplant |
$540.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,481.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,164.87
|
| Rate for Payer: Caremore Medicare Advantage |
$271.46
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$630.00
|
| Rate for Payer: Cigna of CA PPO |
$630.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$271.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$271.46
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$675.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$445.20
|
| Rate for Payer: IEHP medi-cal |
$447.92
|
| Rate for Payer: IEHP Medicare Advantage |
$271.46
|
| Rate for Payer: Innovage PACE Commercial |
$407.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$363.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$363.76
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$450.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Medicare |
$287.75
|
| Rate for Payer: Riverside University Health MISP |
$298.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$450.00
|
| Rate for Payer: United Healthcare HMO Rider |
$450.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$407.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$298.61
|
| Rate for Payer: Vantage Medical Group Senior |
$271.46
|
|
|
Carpectomy; 1 bone
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 25210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Carpectomy; all bones of proximal row
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,044.21 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Cartilage graft; costochondral
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 20910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$784.71 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$1,294.77
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
Cartilage graft; nasal septum
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 20912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,482.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,482.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,482.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,723.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,051.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,482.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,482.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,351.30
|
| Rate for Payer: IEHP medi-cal |
$7,396.12
|
| Rate for Payer: IEHP Medicare Advantage |
$4,482.50
|
| Rate for Payer: Innovage PACE Commercial |
$6,723.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,482.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,006.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,006.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,751.45
|
| Rate for Payer: Riverside University Health MISP |
$4,930.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,482.50
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 68382-094-01
|
| Hospital Charge Code |
1711679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 51079-931-01
|
| Hospital Charge Code |
1711679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 51079-931-20
|
| Hospital Charge Code |
1711679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 68382-094-01
|
| Hospital Charge Code |
1711679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 65862-144-01
|
| Hospital Charge Code |
1711679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
NDC 0904-6302-61
|
| Hospital Charge Code |
1711679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 65862-144-01
|
| Hospital Charge Code |
1711679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 68001-151-00
|
| Hospital Charge Code |
1711679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 51079-931-01
|
| Hospital Charge Code |
1711679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
