|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
|
IP
|
$1.23
|
|
|
Service Code
|
NDC 5976215171
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.98
|
| Rate for Payer: Cigna of CA HMO |
$0.86
|
| Rate for Payer: Cigna of CA PPO |
$0.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Senior |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$0.80
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 6068744711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$1.70
|
| Rate for Payer: Cigna of CA PPO |
$1.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Senior |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2.07
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 6233214231
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$27,231.85
|
|
|
Service Code
|
APR-DRG 3834
|
| Min. Negotiated Rate |
$17,199.06 |
| Max. Negotiated Rate |
$27,231.85 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,199.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,495.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,231.85
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$9,722.49
|
|
|
Service Code
|
APR-DRG 3832
|
| Min. Negotiated Rate |
$6,140.52 |
| Max. Negotiated Rate |
$9,722.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,140.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,317.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,722.49
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$7,114.11
|
|
|
Service Code
|
APR-DRG 3831
|
| Min. Negotiated Rate |
$4,493.12 |
| Max. Negotiated Rate |
$7,114.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,493.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,354.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,114.11
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$14,689.49
|
|
|
Service Code
|
APR-DRG 3833
|
| Min. Negotiated Rate |
$9,277.57 |
| Max. Negotiated Rate |
$14,689.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,277.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,055.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,689.49
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$37,407.19
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$37,407.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,407.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,163.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,829.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,832.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,554.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,504.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,705.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,475.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,504.24
|
| Rate for Payer: Prime Health Services Medicare |
$21,734.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$22,921.22
|
|
|
Service Code
|
MSDRG 603
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$22,921.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,921.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,806.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,729.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,306.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,204.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,913.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,078.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,303.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,913.09
|
| Rate for Payer: Prime Health Services Medicare |
$13,687.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [222941]
|
Facility
|
OP
|
$2,006.23
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$1,805.61 |
| Rate for Payer: Adventist Health Commercial |
$401.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.17
|
| Rate for Payer: Blue Shield of California Commercial |
$40.01
|
| Rate for Payer: Blue Shield of California EPN |
$36.37
|
| Rate for Payer: Cash Price |
$902.80
|
| Rate for Payer: Cash Price |
$902.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,604.98
|
| Rate for Payer: Cigna of CA HMO |
$1,404.36
|
| Rate for Payer: Cigna of CA PPO |
$1,404.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,404.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.96
|
| Rate for Payer: EPIC Health Plan Senior |
$32.64
|
| Rate for Payer: Galaxy Health WC |
$1,705.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,203.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,805.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,273.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.76
|
| Rate for Payer: Multiplan Commercial |
$1,504.67
|
| Rate for Payer: Networks By Design Commercial |
$1,003.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.67
|
| Rate for Payer: Prime Health Services Commercial |
$1,705.30
|
| Rate for Payer: Prime Health Services Medicare |
$31.45
|
| Rate for Payer: Riverside University Health System MISP |
$32.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,203.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,203.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$752.94
|
| Rate for Payer: United Healthcare All Other HMO |
$732.88
|
| Rate for Payer: United Healthcare HMO Rider |
$717.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$657.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Vantage Medical Group Senior |
$32.64
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [222941]
|
Facility
|
IP
|
$2,006.23
|
|
|
Service Code
|
HCPCS J9119
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$401.25 |
| Max. Negotiated Rate |
$1,805.61 |
| Rate for Payer: Adventist Health Commercial |
$401.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,609.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,011.14
|
| Rate for Payer: Cash Price |
$902.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,604.98
|
| Rate for Payer: Cigna of CA HMO |
$1,404.36
|
| Rate for Payer: Cigna of CA PPO |
$1,404.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,404.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.49
|
| Rate for Payer: EPIC Health Plan Senior |
$802.49
|
| Rate for Payer: Galaxy Health WC |
$1,705.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,203.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,805.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,273.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,183.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$1,504.67
|
| Rate for Payer: Networks By Design Commercial |
$1,003.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,705.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$752.94
|
| Rate for Payer: United Healthcare All Other HMO |
$732.88
|
| Rate for Payer: United Healthcare HMO Rider |
$717.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$657.04
|
|
|
CENTRUROIDES (SCORPION) POLYVALENT ANTIVENOM 35 MG IV SOLUTION [153126]
|
Facility
|
OP
|
$6,295.32
|
|
|
Service Code
|
HCPCS J0716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,259.06 |
| Max. Negotiated Rate |
$32,059.77 |
| Rate for Payer: Adventist Health Commercial |
$1,259.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,059.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,351.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,462.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,721.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,215.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,004.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,924.85
|
| Rate for Payer: Blue Shield of California EPN |
$6,295.32
|
| Rate for Payer: Cash Price |
$2,832.89
|
| Rate for Payer: Cash Price |
$2,832.89
|
| Rate for Payer: Central Health Plan Commercial |
$5,036.26
|
| Rate for Payer: Cigna of CA HMO |
$4,406.72
|
| Rate for Payer: Cigna of CA PPO |
$4,406.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,351.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,351.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,351.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,406.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,518.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.13
|
| Rate for Payer: Galaxy Health WC |
$5,351.02
|
| Rate for Payer: Global Benefits Group Commercial |
$3,777.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,665.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,030.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,997.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,976.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,714.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,406.72
|
| Rate for Payer: Multiplan Commercial |
$4,721.49
|
| Rate for Payer: Networks By Design Commercial |
$3,147.66
|
| Rate for Payer: Prime Health Services Commercial |
$5,351.02
|
| Rate for Payer: Riverside University Health System MISP |
$2,518.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,777.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,777.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,362.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,299.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,249.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,061.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,351.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,351.02
|
| Rate for Payer: Vantage Medical Group Senior |
$5,351.02
|
|
|
CENTRUROIDES (SCORPION) POLYVALENT ANTIVENOM 35 MG IV SOLUTION [153126]
|
Facility
|
IP
|
$6,295.32
|
|
|
Service Code
|
HCPCS J0716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,259.06 |
| Max. Negotiated Rate |
$5,665.79 |
| Rate for Payer: Adventist Health Commercial |
$1,259.06
|
| Rate for Payer: Blue Shield of California Commercial |
$5,048.85
|
| Rate for Payer: Blue Shield of California EPN |
$3,172.84
|
| Rate for Payer: Cash Price |
$2,832.89
|
| Rate for Payer: Central Health Plan Commercial |
$5,036.26
|
| Rate for Payer: Cigna of CA HMO |
$4,406.72
|
| Rate for Payer: Cigna of CA PPO |
$4,406.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,406.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,518.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.13
|
| Rate for Payer: Galaxy Health WC |
$5,351.02
|
| Rate for Payer: Global Benefits Group Commercial |
$3,777.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,665.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,997.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,714.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.06
|
| Rate for Payer: Multiplan Commercial |
$4,721.49
|
| Rate for Payer: Networks By Design Commercial |
$3,147.66
|
| Rate for Payer: Prime Health Services Commercial |
$5,351.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,362.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,299.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,249.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,061.72
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 6787754468
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| 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 |
$0.05
|
| 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: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 6818044001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 6787754468
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| 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
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 6818044001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 0093417573
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
CEPHALEXIN 125 MG/5 ML ORAL SUSPENSION [9501]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 0093417573
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 0093417774
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 0093417773
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 0093417773
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 6787754568
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| 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: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| 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: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0093417774
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION [9502]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 6787754568
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| 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
|
|
