|
LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$468.73 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$468.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
LIGATION OR BIOPSY, TEMPORAL ARTERY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 37609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,124.23 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$99,038.40
|
|
|
Service Code
|
MSDRG 956
|
| Min. Negotiated Rate |
$25,608.00 |
| Max. Negotiated Rate |
$99,038.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99,038.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63,974.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89,566.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$87,121.77
|
| Rate for Payer: EPIC Health Plan Senior |
$58,081.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$52,801.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73,921.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70,753.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$52,801.07
|
| Rate for Payer: Prime Health Services Medicare |
$55,969.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$91,491.00
|
| Rate for Payer: United Healthcare All Other HMO |
$91,491.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44,920.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41,155.00
|
|
|
LIMITED PHARYNGECTOMY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 42890
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,285.84 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,285.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,420.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
LINACLOTIDE 145 MCG CAPSULE [199379]
|
Facility
|
OP
|
$11.30
|
|
|
Service Code
|
NDC 0456120130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7.16
|
| Rate for Payer: Blue Shield of California EPN |
$4.51
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$9.04
|
| Rate for Payer: Cigna of CA HMO |
$7.91
|
| Rate for Payer: Cigna of CA PPO |
$7.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$9.61
|
| Rate for Payer: Global Benefits Group Commercial |
$6.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.91
|
| Rate for Payer: Multiplan Commercial |
$8.47
|
| Rate for Payer: Networks By Design Commercial |
$7.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.61
|
| Rate for Payer: Riverside University Health System MISP |
$4.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Vantage Medical Group Senior |
$9.61
|
|
|
LINACLOTIDE 145 MCG CAPSULE [199379]
|
Facility
|
IP
|
$11.30
|
|
|
Service Code
|
NDC 0456120130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$9.06
|
| Rate for Payer: Blue Shield of California EPN |
$5.70
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$9.04
|
| Rate for Payer: Cigna of CA HMO |
$7.91
|
| Rate for Payer: Cigna of CA PPO |
$7.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$9.61
|
| Rate for Payer: Global Benefits Group Commercial |
$6.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.47
|
| Rate for Payer: Networks By Design Commercial |
$7.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.61
|
|
|
LINACLOTIDE 290 MCG CAPSULE [199380]
|
Facility
|
OP
|
$11.30
|
|
|
Service Code
|
NDC 0456120230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7.16
|
| Rate for Payer: Blue Shield of California EPN |
$4.51
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$9.04
|
| Rate for Payer: Cigna of CA HMO |
$7.91
|
| Rate for Payer: Cigna of CA PPO |
$7.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$9.61
|
| Rate for Payer: Global Benefits Group Commercial |
$6.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.91
|
| Rate for Payer: Multiplan Commercial |
$8.47
|
| Rate for Payer: Networks By Design Commercial |
$7.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.61
|
| Rate for Payer: Riverside University Health System MISP |
$4.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Vantage Medical Group Senior |
$9.61
|
|
|
LINACLOTIDE 290 MCG CAPSULE [199380]
|
Facility
|
IP
|
$11.30
|
|
|
Service Code
|
NDC 0456120230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$9.06
|
| Rate for Payer: Blue Shield of California EPN |
$5.70
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$9.04
|
| Rate for Payer: Cigna of CA HMO |
$7.91
|
| Rate for Payer: Cigna of CA PPO |
$7.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.52
|
| Rate for Payer: Galaxy Health WC |
$9.61
|
| Rate for Payer: Global Benefits Group Commercial |
$6.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.47
|
| Rate for Payer: Networks By Design Commercial |
$7.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.61
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 6068775405
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Central Health Plan Commercial |
$2.15
|
| Rate for Payer: Cigna of CA HMO |
$1.88
|
| Rate for Payer: Cigna of CA PPO |
$1.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
| Rate for Payer: Riverside University Health System MISP |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 6068775405
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.36
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Central Health Plan Commercial |
$2.15
|
| Rate for Payer: Cigna of CA HMO |
$1.88
|
| Rate for Payer: Cigna of CA PPO |
$1.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
NDC 3172286525
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.76
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.76
|
| Rate for Payer: Riverside University Health System MISP |
$1.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.76
|
| Rate for Payer: Vantage Medical Group Senior |
$3.76
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [28225]
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
NDC 3172286525
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.76
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.76
|
|
|
LINEZOLID 600 MG/300 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [210366]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
HCPCS J2021
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| 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 |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
|
|
LINEZOLID 600 MG/300 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [210366]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
HCPCS J2021
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$52.18 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.27
|
| 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 |
$41.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.18
|
| Rate for Payer: Blue Shield of California Commercial |
$30.71
|
| Rate for Payer: Blue Shield of California EPN |
$27.92
|
| Rate for Payer: Cash Price |
$0.13
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$34.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.10
|
| 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 |
$0.14
|
| 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 |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| 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
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$7.40
|
|
|
Service Code
|
NDC 6068730921
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.95
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Central Health Plan Commercial |
$5.92
|
| Rate for Payer: Cigna of CA HMO |
$5.18
|
| Rate for Payer: Cigna of CA PPO |
$5.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: EPIC Health Plan Senior |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$6.29
|
| Rate for Payer: Global Benefits Group Commercial |
$4.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$6.29
|
| Rate for Payer: Riverside University Health System MISP |
$2.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Other HMO |
$3.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.29
|
| Rate for Payer: Vantage Medical Group Senior |
$6.29
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6787741933
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$7.40
|
|
|
Service Code
|
NDC 6068730921
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Blue Shield of California EPN |
$3.73
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Central Health Plan Commercial |
$5.92
|
| Rate for Payer: Cigna of CA HMO |
$5.18
|
| Rate for Payer: Cigna of CA PPO |
$5.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: EPIC Health Plan Senior |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$6.29
|
| Rate for Payer: Global Benefits Group Commercial |
$4.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$6.29
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 6787741984
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 6787741933
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$7.40
|
|
|
Service Code
|
NDC 6068730911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.95
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Central Health Plan Commercial |
$5.92
|
| Rate for Payer: Cigna of CA HMO |
$5.18
|
| Rate for Payer: Cigna of CA PPO |
$5.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: EPIC Health Plan Senior |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$6.29
|
| Rate for Payer: Global Benefits Group Commercial |
$4.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$6.29
|
| Rate for Payer: Riverside University Health System MISP |
$2.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Other HMO |
$3.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.29
|
| Rate for Payer: Vantage Medical Group Senior |
$6.29
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 3172274920
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$2.81
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Central Health Plan Commercial |
$5.64
|
| Rate for Payer: Cigna of CA HMO |
$4.93
|
| Rate for Payer: Cigna of CA PPO |
$4.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.93
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
| Rate for Payer: Riverside University Health System MISP |
$2.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 3172274920
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5.65
|
| Rate for Payer: Blue Shield of California EPN |
$3.55
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Central Health Plan Commercial |
$5.64
|
| Rate for Payer: Cigna of CA HMO |
$4.93
|
| Rate for Payer: Cigna of CA PPO |
$4.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$7.43
|
|
|
Service Code
|
NDC 0904655304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.69 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$4.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.96
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Central Health Plan Commercial |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$5.20
|
| Rate for Payer: Cigna of CA PPO |
$5.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: EPIC Health Plan Senior |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Networks By Design Commercial |
$4.83
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
| Rate for Payer: Riverside University Health System MISP |
$2.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.71
|
| Rate for Payer: United Healthcare All Other HMO |
$3.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
IP
|
$7.40
|
|
|
Service Code
|
NDC 6068730911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Blue Shield of California EPN |
$3.73
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Central Health Plan Commercial |
$5.92
|
| Rate for Payer: Cigna of CA HMO |
$5.18
|
| Rate for Payer: Cigna of CA PPO |
$5.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: EPIC Health Plan Senior |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$6.29
|
| Rate for Payer: Global Benefits Group Commercial |
$4.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$6.29
|
|
|
LINEZOLID 600 MG TABLET [28224]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6787741984
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
