|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]
|
Facility
IP
|
$3.51
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
ERX1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.81
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]
|
Facility
OP
|
$3.51
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
ERX1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.62
|
| Rate for Payer: BCBS Transplant Transplant |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.81
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.63
|
| Rate for Payer: IEHP medi-cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Riverside University Health MISP |
$1.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
|
|
CEFUROXIME (ZINACEF) 1.5G/15ML FROZEN SYRINGE [4081783]
|
Facility
OP
|
$6.36
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
NDC4081783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.62
|
| Rate for Payer: BCBS Transplant Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.77
|
| Rate for Payer: IEHP medi-cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Riverside University Health MISP |
$2.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
CEFUROXIME (ZINACEF) 1.5G/15ML FROZEN SYRINGE [4081783]
|
Facility
IP
|
$6.36
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
NDC4081783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.77
|
| Rate for Payer: Blue Shield of California EPN |
$3.40
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$1.45
|
|
|
Service Code
|
NDC 0904-6502-61
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.23
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$1.74
|
|
|
Service Code
|
NDC 60687-436-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: BCBS Transplant Transplant |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.30
|
| Rate for Payer: IEHP medi-cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: Riverside University Health MISP |
$0.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.87
|
| Rate for Payer: United Healthcare HMO Rider |
$0.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
NDC 60687-436-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 33342-156-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$11.44
|
|
|
Service Code
|
NDC 0025-1520-34
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: BCBS Transplant Transplant |
$6.86
|
| Rate for Payer: Blue Shield of California Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$5.15
|
| Rate for Payer: Central Health Plan Commercial |
$9.15
|
| Rate for Payer: Cigna of CA HMO |
$8.01
|
| Rate for Payer: Cigna of CA PPO |
$8.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.58
|
| Rate for Payer: Galaxy Health WC |
$9.72
|
| Rate for Payer: Global Benefits Group Commercial |
$6.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.58
|
| Rate for Payer: IEHP medi-cal |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$8.58
|
| Rate for Payer: Networks By Design Commercial |
$7.44
|
| Rate for Payer: Prime Health Services Commercial |
$9.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.86
|
| Rate for Payer: Riverside University Health MISP |
$4.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.72
|
| Rate for Payer: United Healthcare All Other HMO |
$5.72
|
| Rate for Payer: United Healthcare HMO Rider |
$5.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.72
|
| Rate for Payer: Vantage Medical Group Senior |
$9.72
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 62332-141-31
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
| Rate for Payer: IEHP medi-cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 62332-141-31
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 33342-156-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$1.45
|
|
|
Service Code
|
NDC 0904-6502-61
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: BCBS Transplant Transplant |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.09
|
| Rate for Payer: IEHP medi-cal |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.87
|
| Rate for Payer: Riverside University Health MISP |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1.23
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$11.44
|
|
|
Service Code
|
NDC 0025-1520-34
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8.58
|
| Rate for Payer: Blue Shield of California EPN |
$6.11
|
| Rate for Payer: Cash Price |
$5.15
|
| Rate for Payer: Cash Price |
$5.15
|
| Rate for Payer: Central Health Plan Commercial |
$9.15
|
| Rate for Payer: Cigna of CA HMO |
$8.01
|
| Rate for Payer: Cigna of CA PPO |
$8.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.58
|
| Rate for Payer: Galaxy Health WC |
$9.72
|
| Rate for Payer: Global Benefits Group Commercial |
$6.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$8.58
|
| Rate for Payer: Networks By Design Commercial |
$7.44
|
| Rate for Payer: Prime Health Services Commercial |
$9.72
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$1.23
|
|
|
Service Code
|
NDC 59762-1517-1
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: BCBS Transplant Transplant |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| 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: Dignity Health Commercial/Exchange |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.92
|
| Rate for Payer: IEHP medi-cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.82
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: Riverside University Health MISP |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$18.76
|
|
|
Service Code
|
NDC 0025-1525-34
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.07
|
| Rate for Payer: Blue Shield of California EPN |
$10.02
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Central Health Plan Commercial |
$15.01
|
| Rate for Payer: Cigna of CA HMO |
$13.13
|
| Rate for Payer: Cigna of CA PPO |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.50
|
| Rate for Payer: Galaxy Health WC |
$15.95
|
| Rate for Payer: Global Benefits Group Commercial |
$11.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$14.07
|
| Rate for Payer: Networks By Design Commercial |
$12.19
|
| Rate for Payer: Prime Health Services Commercial |
$15.95
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$18.76
|
|
|
Service Code
|
NDC 0025-1525-34
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.08
|
| Rate for Payer: BCBS Transplant Transplant |
$11.26
|
| Rate for Payer: Blue Shield of California Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California EPN |
$9.17
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Central Health Plan Commercial |
$15.01
|
| Rate for Payer: Cigna of CA HMO |
$13.13
|
| Rate for Payer: Cigna of CA PPO |
$13.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.50
|
| Rate for Payer: Galaxy Health WC |
$15.95
|
| Rate for Payer: Global Benefits Group Commercial |
$11.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.07
|
| Rate for Payer: IEHP medi-cal |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$14.07
|
| Rate for Payer: Networks By Design Commercial |
$12.19
|
| Rate for Payer: Prime Health Services Commercial |
$15.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.26
|
| Rate for Payer: Riverside University Health MISP |
$7.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.38
|
| Rate for Payer: United Healthcare HMO Rider |
$9.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Vantage Medical Group Senior |
$15.95
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$6.04
|
|
|
Service Code
|
NDC 51079-215-01
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Central Health Plan Commercial |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$4.23
|
| Rate for Payer: Cigna of CA PPO |
$4.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$1.23
|
|
|
Service Code
|
NDC 59762-1517-1
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.55
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.82
|
| 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
IP
|
$0.12
|
|
|
Service Code
|
NDC 72241-024-05
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$2.43
|
|
|
Service Code
|
NDC 60687-447-11
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| 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: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1.82
|
| Rate for Payer: IEHP medi-cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.46
|
| Rate for Payer: Riverside University Health 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 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 62332-142-31
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.48
|
| 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
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$6.04
|
|
|
Service Code
|
NDC 51079-215-01
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: BCBS Transplant Transplant |
$3.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3.80
|
| Rate for Payer: Blue Shield of California EPN |
$2.95
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Central Health Plan Commercial |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$4.23
|
| Rate for Payer: Cigna of CA PPO |
$4.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.53
|
| Rate for Payer: IEHP medi-cal |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: Riverside University Health MISP |
$2.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$2.43
|
|
|
Service Code
|
NDC 60687-447-11
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.30
|
| Rate for Payer: Cash Price |
$1.09
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.07
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$6.04
|
|
|
Service Code
|
NDC 51079-215-20
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Central Health Plan Commercial |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$4.23
|
| Rate for Payer: Cigna of CA PPO |
$4.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
