|
CARVEDILOL PHOSPHATE ER 10 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77664]
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 57664-663-83
|
| Hospital Charge Code |
1711920
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Blue Shield of California Commercial |
$7.43
|
| Rate for Payer: Blue Shield of California EPN |
$5.29
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.93
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.43
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
IP
|
$9.51
|
|
|
Service Code
|
NDC 60505-4714-3
|
| Hospital Charge Code |
1711921
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 69784-714-13
|
| Hospital Charge Code |
1711921
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.85
|
| Rate for Payer: Blue Distinction Transplant |
$5.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.85
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.93
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.42
|
| Rate for Payer: Dignity Health Media |
$8.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.43
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Riverside University Health System MISP |
$3.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 57664-664-83
|
| Hospital Charge Code |
1711921
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Blue Shield of California Commercial |
$7.43
|
| Rate for Payer: Blue Shield of California EPN |
$5.29
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.93
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.43
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 57664-664-83
|
| Hospital Charge Code |
1711921
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.85
|
| Rate for Payer: Blue Distinction Transplant |
$5.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.85
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.93
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.42
|
| Rate for Payer: Dignity Health Media |
$8.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.43
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Riverside University Health System MISP |
$3.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 69784-714-13
|
| Hospital Charge Code |
1711921
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Blue Shield of California Commercial |
$7.43
|
| Rate for Payer: Blue Shield of California EPN |
$5.29
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.93
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.43
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
OP
|
$9.51
|
|
|
Service Code
|
NDC 60505-4714-3
|
| Hospital Charge Code |
1711921
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.62
|
| Rate for Payer: Blue Distinction Transplant |
$5.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$4.65
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
| Rate for Payer: Riverside University Health System MISP |
$3.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
OP
|
$9.51
|
|
|
Service Code
|
NDC 60505-3679-3
|
| Hospital Charge Code |
1711921
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.62
|
| Rate for Payer: Blue Distinction Transplant |
$5.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$4.65
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
| Rate for Payer: Riverside University Health System MISP |
$3.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]
|
Facility
|
IP
|
$9.51
|
|
|
Service Code
|
NDC 60505-3679-3
|
| Hospital Charge Code |
1711921
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
|
|
CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]
|
Facility
|
IP
|
$82.80
|
|
|
Service Code
|
CPT J0637
|
| Hospital Charge Code |
1759988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Blue Shield of California Commercial |
$62.10
|
| Rate for Payer: Blue Shield of California Commercial |
$64.08
|
| Rate for Payer: Blue Shield of California EPN |
$44.22
|
| Rate for Payer: Blue Shield of California EPN |
$45.62
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Cash Price |
$37.26
|
| Rate for Payer: Central Health Plan Commercial |
$68.35
|
| Rate for Payer: Central Health Plan Commercial |
$66.24
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA HMO |
$59.81
|
| Rate for Payer: Cigna of CA PPO |
$59.81
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.18
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Galaxy Health WC |
$72.62
|
| Rate for Payer: Global Benefits Group Commercial |
$51.26
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$62.10
|
| Rate for Payer: Multiplan Commercial |
$64.08
|
| Rate for Payer: Networks By Design Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Prime Health Services Commercial |
$72.62
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.54
|
| Rate for Payer: United Healthcare All Other HMO |
$31.51
|
| Rate for Payer: United Healthcare HMO Rider |
$29.87
|
| Rate for Payer: United Healthcare HMO Rider |
$30.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
|
|
CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]
|
Facility
|
OP
|
$82.80
|
|
|
Service Code
|
CPT J0637
|
| Hospital Charge Code |
1759988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.03
|
| Rate for Payer: Blue Distinction Transplant |
$51.26
|
| Rate for Payer: Blue Distinction Transplant |
$49.68
|
| Rate for Payer: Blue Shield of California Commercial |
$12.93
|
| Rate for Payer: Blue Shield of California Commercial |
$12.93
|
| Rate for Payer: Blue Shield of California EPN |
$11.75
|
| Rate for Payer: Blue Shield of California EPN |
$11.75
|
| Rate for Payer: Cash Price |
$37.26
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Cash Price |
$37.26
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Central Health Plan Commercial |
$66.24
|
| Rate for Payer: Central Health Plan Commercial |
$68.35
|
| Rate for Payer: Cigna of CA HMO |
$59.81
|
| Rate for Payer: Cigna of CA HMO |
$57.96
|
| Rate for Payer: Cigna of CA PPO |
$59.81
|
| Rate for Payer: Cigna of CA PPO |
$57.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.38
|
| Rate for Payer: Dignity Health Media |
$72.62
|
| Rate for Payer: Dignity Health Media |
$70.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.12
|
| Rate for Payer: Galaxy Health WC |
$70.38
|
| Rate for Payer: Galaxy Health WC |
$72.62
|
| Rate for Payer: Global Benefits Group Commercial |
$51.26
|
| Rate for Payer: Global Benefits Group Commercial |
$49.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$62.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.09
|
| Rate for Payer: Multiplan Commercial |
$62.10
|
| Rate for Payer: Multiplan Commercial |
$64.08
|
| Rate for Payer: Networks By Design Commercial |
$41.40
|
| Rate for Payer: Networks By Design Commercial |
$42.72
|
| Rate for Payer: Prime Health Services Commercial |
$72.62
|
| Rate for Payer: Prime Health Services Commercial |
$70.38
|
| Rate for Payer: Riverside University Health System MISP |
$34.18
|
| Rate for Payer: Riverside University Health System MISP |
$33.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.72
|
| Rate for Payer: United Healthcare All Other HMO |
$42.72
|
| Rate for Payer: United Healthcare All Other HMO |
$41.40
|
| Rate for Payer: United Healthcare HMO Rider |
$42.72
|
| Rate for Payer: United Healthcare HMO Rider |
$41.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.38
|
| Rate for Payer: Vantage Medical Group Senior |
$70.38
|
| Rate for Payer: Vantage Medical Group Senior |
$72.62
|
|
|
CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]
|
Facility
|
OP
|
$118.80
|
|
|
Service Code
|
CPT J0637
|
| Hospital Charge Code |
1759997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$106.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.03
|
| Rate for Payer: Blue Distinction Transplant |
$71.28
|
| Rate for Payer: Blue Shield of California Commercial |
$12.93
|
| Rate for Payer: Blue Shield of California EPN |
$11.75
|
| Rate for Payer: Cash Price |
$53.46
|
| Rate for Payer: Cash Price |
$53.46
|
| Rate for Payer: Central Health Plan Commercial |
$95.04
|
| Rate for Payer: Cigna of CA HMO |
$83.16
|
| Rate for Payer: Cigna of CA PPO |
$83.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.98
|
| Rate for Payer: Dignity Health Media |
$100.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.52
|
| Rate for Payer: Galaxy Health WC |
$100.98
|
| Rate for Payer: Global Benefits Group Commercial |
$71.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$89.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Multiplan Commercial |
$89.10
|
| Rate for Payer: Networks By Design Commercial |
$59.40
|
| Rate for Payer: Prime Health Services Commercial |
$100.98
|
| Rate for Payer: Riverside University Health System MISP |
$47.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.40
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$59.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.98
|
| Rate for Payer: Vantage Medical Group Senior |
$100.98
|
|
|
CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]
|
Facility
|
IP
|
$118.80
|
|
|
Service Code
|
CPT J0637
|
| Hospital Charge Code |
1759997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$106.92 |
| Rate for Payer: Blue Shield of California Commercial |
$89.10
|
| Rate for Payer: Blue Shield of California EPN |
$63.44
|
| Rate for Payer: Cash Price |
$53.46
|
| Rate for Payer: Central Health Plan Commercial |
$95.04
|
| Rate for Payer: Cigna of CA HMO |
$83.16
|
| Rate for Payer: Cigna of CA PPO |
$83.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.52
|
| Rate for Payer: Galaxy Health WC |
$100.98
|
| Rate for Payer: Global Benefits Group Commercial |
$71.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.76
|
| Rate for Payer: Multiplan Commercial |
$89.10
|
| Rate for Payer: Networks By Design Commercial |
$59.40
|
| Rate for Payer: Prime Health Services Commercial |
$100.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.86
|
| Rate for Payer: United Healthcare All Other HMO |
$43.81
|
| Rate for Payer: United Healthcare HMO Rider |
$42.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.20
|
|
|
CATH HDA TRAY 12.5FRX20CM
|
Facility
|
OP
|
$895.57
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.11 |
| Max. Negotiated Rate |
$806.01 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$492.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.83
|
| Rate for Payer: Blue Distinction Transplant |
$537.34
|
| Rate for Payer: Blue Shield of California Commercial |
$671.68
|
| Rate for Payer: Blue Shield of California EPN |
$487.19
|
| Rate for Payer: Cash Price |
$403.01
|
| Rate for Payer: Central Health Plan Commercial |
$716.46
|
| Rate for Payer: Cigna of CA HMO |
$626.90
|
| Rate for Payer: Cigna of CA PPO |
$626.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.23
|
| Rate for Payer: Dignity Health Media |
$761.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$761.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$358.23
|
| Rate for Payer: Galaxy Health WC |
$761.23
|
| Rate for Payer: Global Benefits Group Commercial |
$537.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$806.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$671.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$313.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$597.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.11
|
| Rate for Payer: Multiplan Commercial |
$671.68
|
| Rate for Payer: Networks By Design Commercial |
$447.78
|
| Rate for Payer: Prime Health Services Commercial |
$761.23
|
| Rate for Payer: Riverside University Health System MISP |
$358.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.78
|
| Rate for Payer: United Healthcare All Other HMO |
$447.78
|
| Rate for Payer: United Healthcare HMO Rider |
$447.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$447.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$761.23
|
| Rate for Payer: Vantage Medical Group Senior |
$761.23
|
|
|
CATH HDA TRAY 12.5FRX20CM
|
Facility
|
IP
|
$895.57
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
901698321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.11 |
| Max. Negotiated Rate |
$806.01 |
| Rate for Payer: Blue Shield of California EPN |
$478.23
|
| Rate for Payer: Cash Price |
$403.01
|
| Rate for Payer: Central Health Plan Commercial |
$716.46
|
| Rate for Payer: Cigna of CA HMO |
$626.90
|
| Rate for Payer: Cigna of CA PPO |
$626.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$358.23
|
| Rate for Payer: Galaxy Health WC |
$761.23
|
| Rate for Payer: Global Benefits Group Commercial |
$537.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$806.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$597.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.11
|
| Rate for Payer: Multiplan Commercial |
$671.68
|
| Rate for Payer: Prime Health Services Commercial |
$761.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$338.17
|
| Rate for Payer: United Healthcare All Other HMO |
$330.29
|
| Rate for Payer: United Healthcare HMO Rider |
$323.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.54
|
|
|
Cautery of cervix; laser ablation
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 57513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$417.83 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
CEFACLOR 250 MG/5 ML ORAL SUSPENSION [9434]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 16571-071-12
|
| Hospital Charge Code |
NDG9434
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
CEFACLOR 250 MG/5 ML ORAL SUSPENSION [9434]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 16571-071-12
|
| Hospital Charge Code |
NDG9434
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: Blue Distinction Transplant |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Media |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
CEFACLOR 500 MG CAPSULE [9431]
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 61442-172-30
|
| Hospital Charge Code |
1712040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
|
|
CEFACLOR 500 MG CAPSULE [9431]
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 61442-172-30
|
| Hospital Charge Code |
1712040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.69
|
| Rate for Payer: Blue Distinction Transplant |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: Dignity Health Media |
$2.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
| Rate for Payer: Riverside University Health System MISP |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 68180-180-08
|
| Hospital Charge Code |
ERX9436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Distinction Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Media |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 0093-3196-53
|
| Hospital Charge Code |
ERX9436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Distinction Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Media |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 68180-180-08
|
| Hospital Charge Code |
ERX9436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 0093-3196-53
|
| Hospital Charge Code |
ERX9436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJ (100MG/ML IVPB) [1446]
|
Facility
|
OP
|
$14.40
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
1750334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.90
|
| Rate for Payer: Blue Distinction Transplant |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Central Health Plan Commercial |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Media |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Riverside University Health System MISP |
$5.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
|
