BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]
|
Facility
|
IP
|
$0.15
|
|
Service Code
|
NDC 16729-443-15
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.08
|
Rate for Payer: Central Health Plan Commercial |
$0.12
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Senior |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.13
|
Rate for Payer: Global Benefits Group Commercial |
$0.09
|
Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.11
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]
|
Facility
|
IP
|
$1.58
|
|
Service Code
|
NDC 0904-7084-04
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.32 |
Max. Negotiated Rate |
$1.42 |
Rate for Payer: Adventist Health Commercial |
$0.32
|
Rate for Payer: Blue Shield of California Commercial |
$1.22
|
Rate for Payer: Blue Shield of California EPN |
$0.80
|
Rate for Payer: Cash Price |
$0.87
|
Rate for Payer: Central Health Plan Commercial |
$1.26
|
Rate for Payer: Cigna of CA HMO |
$1.11
|
Rate for Payer: Cigna of CA PPO |
$1.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
Rate for Payer: EPIC Health Plan Senior |
$0.63
|
Rate for Payer: Galaxy Health WC |
$1.34
|
Rate for Payer: Global Benefits Group Commercial |
$0.95
|
Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.98
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
Rate for Payer: Multiplan Commercial |
$1.19
|
Rate for Payer: Networks By Design Commercial |
$1.03
|
Rate for Payer: Prime Health Services Commercial |
$1.34
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]
|
Facility
|
OP
|
$1.58
|
|
Service Code
|
NDC 0904-7084-04
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.32 |
Max. Negotiated Rate |
$1.42 |
Rate for Payer: Adventist Health Commercial |
$0.32
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.34
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.87
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.19
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
Rate for Payer: Blue Shield of California Commercial |
$0.97
|
Rate for Payer: Blue Shield of California EPN |
$0.63
|
Rate for Payer: Cash Price |
$0.87
|
Rate for Payer: Central Health Plan Commercial |
$1.26
|
Rate for Payer: Cigna of CA HMO |
$1.11
|
Rate for Payer: Cigna of CA PPO |
$1.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
Rate for Payer: Dignity Health Medi-Cal |
$1.34
|
Rate for Payer: Dignity Health Medicare Advantage |
$1.34
|
Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
Rate for Payer: EPIC Health Plan Senior |
$0.63
|
Rate for Payer: Galaxy Health WC |
$1.34
|
Rate for Payer: Global Benefits Group Commercial |
$0.95
|
Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
Rate for Payer: InnovAge PACE Commercial |
$0.79
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.98
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.11
|
Rate for Payer: Molina Healthcare of CA Medicare |
$1.11
|
Rate for Payer: Multiplan Commercial |
$1.19
|
Rate for Payer: Networks By Design Commercial |
$1.03
|
Rate for Payer: Prime Health Services Commercial |
$1.34
|
Rate for Payer: Riverside University Health System MISP |
$0.63
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
Rate for Payer: United Healthcare All Other HMO |
$0.79
|
Rate for Payer: United Healthcare HMO Rider |
$0.79
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.34
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]
|
Facility
|
IP
|
$2.22
|
|
Service Code
|
NDC 60687-782-11
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.44 |
Max. Negotiated Rate |
$2.00 |
Rate for Payer: Adventist Health Commercial |
$0.44
|
Rate for Payer: Blue Shield of California Commercial |
$1.72
|
Rate for Payer: Blue Shield of California EPN |
$1.12
|
Rate for Payer: Cash Price |
$1.22
|
Rate for Payer: Central Health Plan Commercial |
$1.78
|
Rate for Payer: Cigna of CA HMO |
$1.55
|
Rate for Payer: Cigna of CA PPO |
$1.55
|
Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
Rate for Payer: EPIC Health Plan Senior |
$0.89
|
Rate for Payer: Galaxy Health WC |
$1.89
|
Rate for Payer: Global Benefits Group Commercial |
$1.33
|
Rate for Payer: Health Management Network EPO/PPO |
$2.00
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.48
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.37
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
Rate for Payer: Multiplan Commercial |
$1.67
|
Rate for Payer: Networks By Design Commercial |
$1.44
|
Rate for Payer: Prime Health Services Commercial |
$1.89
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]
|
Facility
|
OP
|
$0.22
|
|
Service Code
|
NDC 68180-319-06
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.12
|
Rate for Payer: Central Health Plan Commercial |
$0.18
|
Rate for Payer: Cigna of CA HMO |
$0.15
|
Rate for Payer: Cigna of CA PPO |
$0.15
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: EPIC Health Plan Senior |
$0.09
|
Rate for Payer: Galaxy Health WC |
$0.19
|
Rate for Payer: Global Benefits Group Commercial |
$0.13
|
Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
Rate for Payer: InnovAge PACE Commercial |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
Rate for Payer: Multiplan Commercial |
$0.17
|
Rate for Payer: Networks By Design Commercial |
$0.14
|
Rate for Payer: Prime Health Services Commercial |
$0.19
|
Rate for Payer: Riverside University Health System MISP |
$0.09
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
Rate for Payer: United Healthcare All Other HMO |
$0.11
|
Rate for Payer: United Healthcare HMO Rider |
$0.11
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
OP
|
$3.04
|
|
Service Code
|
NDC 68084-252-11
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.61 |
Max. Negotiated Rate |
$2.74 |
Rate for Payer: Adventist Health Commercial |
$0.61
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.85
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.28
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.47
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
Rate for Payer: Blue Shield of California Commercial |
$1.86
|
Rate for Payer: Blue Shield of California EPN |
$1.21
|
Rate for Payer: Cash Price |
$1.67
|
Rate for Payer: Central Health Plan Commercial |
$2.43
|
Rate for Payer: Cigna of CA HMO |
$2.13
|
Rate for Payer: Cigna of CA PPO |
$2.13
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
Rate for Payer: Dignity Health Medicare Advantage |
$2.58
|
Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
Rate for Payer: EPIC Health Plan Senior |
$1.22
|
Rate for Payer: Galaxy Health WC |
$2.58
|
Rate for Payer: Global Benefits Group Commercial |
$1.82
|
Rate for Payer: Health Management Network EPO/PPO |
$2.74
|
Rate for Payer: InnovAge PACE Commercial |
$1.52
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.13
|
Rate for Payer: Molina Healthcare of CA Medicare |
$2.13
|
Rate for Payer: Multiplan Commercial |
$2.28
|
Rate for Payer: Networks By Design Commercial |
$1.98
|
Rate for Payer: Prime Health Services Commercial |
$2.58
|
Rate for Payer: Riverside University Health System MISP |
$1.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
Rate for Payer: United Healthcare All Other Commercial |
$1.52
|
Rate for Payer: United Healthcare All Other HMO |
$1.52
|
Rate for Payer: United Healthcare HMO Rider |
$1.52
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.52
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
IP
|
$3.04
|
|
Service Code
|
NDC 68084-252-21
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.61 |
Max. Negotiated Rate |
$2.74 |
Rate for Payer: Adventist Health Commercial |
$0.61
|
Rate for Payer: Blue Shield of California Commercial |
$2.35
|
Rate for Payer: Blue Shield of California EPN |
$1.53
|
Rate for Payer: Cash Price |
$1.67
|
Rate for Payer: Central Health Plan Commercial |
$2.43
|
Rate for Payer: Cigna of CA HMO |
$2.13
|
Rate for Payer: Cigna of CA PPO |
$2.13
|
Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
Rate for Payer: EPIC Health Plan Senior |
$1.22
|
Rate for Payer: Galaxy Health WC |
$2.58
|
Rate for Payer: Global Benefits Group Commercial |
$1.82
|
Rate for Payer: Health Management Network EPO/PPO |
$2.74
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Multiplan Commercial |
$2.28
|
Rate for Payer: Networks By Design Commercial |
$1.98
|
Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
IP
|
$3.04
|
|
Service Code
|
NDC 60687-793-21
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.61 |
Max. Negotiated Rate |
$2.74 |
Rate for Payer: Adventist Health Commercial |
$0.61
|
Rate for Payer: Blue Shield of California Commercial |
$2.35
|
Rate for Payer: Blue Shield of California EPN |
$1.53
|
Rate for Payer: Cash Price |
$1.67
|
Rate for Payer: Central Health Plan Commercial |
$2.43
|
Rate for Payer: Cigna of CA HMO |
$2.13
|
Rate for Payer: Cigna of CA PPO |
$2.13
|
Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
Rate for Payer: EPIC Health Plan Senior |
$1.22
|
Rate for Payer: Galaxy Health WC |
$2.58
|
Rate for Payer: Global Benefits Group Commercial |
$1.82
|
Rate for Payer: Health Management Network EPO/PPO |
$2.74
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Multiplan Commercial |
$2.28
|
Rate for Payer: Networks By Design Commercial |
$1.98
|
Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
OP
|
$3.04
|
|
Service Code
|
NDC 60687-793-21
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.61 |
Max. Negotiated Rate |
$2.74 |
Rate for Payer: Adventist Health Commercial |
$0.61
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.85
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.28
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.47
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
Rate for Payer: Blue Shield of California Commercial |
$1.86
|
Rate for Payer: Blue Shield of California EPN |
$1.21
|
Rate for Payer: Cash Price |
$1.67
|
Rate for Payer: Central Health Plan Commercial |
$2.43
|
Rate for Payer: Cigna of CA HMO |
$2.13
|
Rate for Payer: Cigna of CA PPO |
$2.13
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
Rate for Payer: Dignity Health Medicare Advantage |
$2.58
|
Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
Rate for Payer: EPIC Health Plan Senior |
$1.22
|
Rate for Payer: Galaxy Health WC |
$2.58
|
Rate for Payer: Global Benefits Group Commercial |
$1.82
|
Rate for Payer: Health Management Network EPO/PPO |
$2.74
|
Rate for Payer: InnovAge PACE Commercial |
$1.52
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.13
|
Rate for Payer: Molina Healthcare of CA Medicare |
$2.13
|
Rate for Payer: Multiplan Commercial |
$2.28
|
Rate for Payer: Networks By Design Commercial |
$1.98
|
Rate for Payer: Prime Health Services Commercial |
$2.58
|
Rate for Payer: Riverside University Health System MISP |
$1.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
Rate for Payer: United Healthcare All Other Commercial |
$1.52
|
Rate for Payer: United Healthcare All Other HMO |
$1.52
|
Rate for Payer: United Healthcare HMO Rider |
$1.52
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.52
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
IP
|
$3.04
|
|
Service Code
|
NDC 68084-252-11
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.61 |
Max. Negotiated Rate |
$2.74 |
Rate for Payer: Adventist Health Commercial |
$0.61
|
Rate for Payer: Blue Shield of California Commercial |
$2.35
|
Rate for Payer: Blue Shield of California EPN |
$1.53
|
Rate for Payer: Cash Price |
$1.67
|
Rate for Payer: Central Health Plan Commercial |
$2.43
|
Rate for Payer: Cigna of CA HMO |
$2.13
|
Rate for Payer: Cigna of CA PPO |
$2.13
|
Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
Rate for Payer: EPIC Health Plan Senior |
$1.22
|
Rate for Payer: Galaxy Health WC |
$2.58
|
Rate for Payer: Global Benefits Group Commercial |
$1.82
|
Rate for Payer: Health Management Network EPO/PPO |
$2.74
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Multiplan Commercial |
$2.28
|
Rate for Payer: Networks By Design Commercial |
$1.98
|
Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
IP
|
$0.48
|
|
Service Code
|
NDC 63304-724-30
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: Adventist Health Commercial |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.37
|
Rate for Payer: Blue Shield of California EPN |
$0.24
|
Rate for Payer: Cash Price |
$0.26
|
Rate for Payer: Central Health Plan Commercial |
$0.38
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
Rate for Payer: EPIC Health Plan Senior |
$0.19
|
Rate for Payer: Galaxy Health WC |
$0.41
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Multiplan Commercial |
$0.36
|
Rate for Payer: Networks By Design Commercial |
$0.31
|
Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
IP
|
$0.19
|
|
Service Code
|
NDC 16729-444-10
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Blue Shield of California Commercial |
$0.15
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Central Health Plan Commercial |
$0.15
|
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 |
$0.08
|
Rate for Payer: EPIC Health Plan Senior |
$0.08
|
Rate for Payer: Galaxy Health WC |
$0.16
|
Rate for Payer: Global Benefits Group Commercial |
$0.11
|
Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$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 |
$0.16
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
OP
|
$3.04
|
|
Service Code
|
NDC 68084-252-21
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.61 |
Max. Negotiated Rate |
$2.74 |
Rate for Payer: Adventist Health Commercial |
$0.61
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.85
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.28
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.47
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
Rate for Payer: Blue Shield of California Commercial |
$1.86
|
Rate for Payer: Blue Shield of California EPN |
$1.21
|
Rate for Payer: Cash Price |
$1.67
|
Rate for Payer: Central Health Plan Commercial |
$2.43
|
Rate for Payer: Cigna of CA HMO |
$2.13
|
Rate for Payer: Cigna of CA PPO |
$2.13
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
Rate for Payer: Dignity Health Medicare Advantage |
$2.58
|
Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
Rate for Payer: EPIC Health Plan Senior |
$1.22
|
Rate for Payer: Galaxy Health WC |
$2.58
|
Rate for Payer: Global Benefits Group Commercial |
$1.82
|
Rate for Payer: Health Management Network EPO/PPO |
$2.74
|
Rate for Payer: InnovAge PACE Commercial |
$1.52
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.13
|
Rate for Payer: Molina Healthcare of CA Medicare |
$2.13
|
Rate for Payer: Multiplan Commercial |
$2.28
|
Rate for Payer: Networks By Design Commercial |
$1.98
|
Rate for Payer: Prime Health Services Commercial |
$2.58
|
Rate for Payer: Riverside University Health System MISP |
$1.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
Rate for Payer: United Healthcare All Other Commercial |
$1.52
|
Rate for Payer: United Healthcare All Other HMO |
$1.52
|
Rate for Payer: United Healthcare HMO Rider |
$1.52
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.52
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
OP
|
$0.48
|
|
Service Code
|
NDC 63304-724-30
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: Adventist Health Commercial |
$0.10
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
Rate for Payer: Blue Shield of California Commercial |
$0.29
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.26
|
Rate for Payer: Central Health Plan Commercial |
$0.38
|
Rate for Payer: Cigna of CA HMO |
$0.34
|
Rate for Payer: Cigna of CA PPO |
$0.34
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
Rate for Payer: EPIC Health Plan Senior |
$0.19
|
Rate for Payer: Galaxy Health WC |
$0.41
|
Rate for Payer: Global Benefits Group Commercial |
$0.29
|
Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
Rate for Payer: InnovAge PACE Commercial |
$0.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
Rate for Payer: Multiplan Commercial |
$0.36
|
Rate for Payer: Networks By Design Commercial |
$0.31
|
Rate for Payer: Prime Health Services Commercial |
$0.41
|
Rate for Payer: Riverside University Health System MISP |
$0.19
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
Rate for Payer: United Healthcare All Other HMO |
$0.24
|
Rate for Payer: United Healthcare HMO Rider |
$0.24
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
IP
|
$3.04
|
|
Service Code
|
NDC 60687-793-11
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.61 |
Max. Negotiated Rate |
$2.74 |
Rate for Payer: Adventist Health Commercial |
$0.61
|
Rate for Payer: Blue Shield of California Commercial |
$2.35
|
Rate for Payer: Blue Shield of California EPN |
$1.53
|
Rate for Payer: Cash Price |
$1.67
|
Rate for Payer: Central Health Plan Commercial |
$2.43
|
Rate for Payer: Cigna of CA HMO |
$2.13
|
Rate for Payer: Cigna of CA PPO |
$2.13
|
Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
Rate for Payer: EPIC Health Plan Senior |
$1.22
|
Rate for Payer: Galaxy Health WC |
$2.58
|
Rate for Payer: Global Benefits Group Commercial |
$1.82
|
Rate for Payer: Health Management Network EPO/PPO |
$2.74
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Multiplan Commercial |
$2.28
|
Rate for Payer: Networks By Design Commercial |
$1.98
|
Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
OP
|
$0.19
|
|
Service Code
|
NDC 16729-444-10
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
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: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.11
|
Rate for Payer: Central Health Plan Commercial |
$0.15
|
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 |
$0.16
|
Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
Rate for Payer: EPIC Health Plan Senior |
$0.08
|
Rate for Payer: Galaxy Health WC |
$0.16
|
Rate for Payer: Global Benefits Group Commercial |
$0.11
|
Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
Rate for Payer: InnovAge PACE Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Networks By Design Commercial |
$0.12
|
Rate for Payer: Prime Health Services Commercial |
$0.16
|
Rate for Payer: Riverside University Health System MISP |
$0.08
|
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 |
$0.10
|
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 |
$0.10
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]
|
Facility
|
OP
|
$3.04
|
|
Service Code
|
NDC 60687-793-11
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.61 |
Max. Negotiated Rate |
$2.74 |
Rate for Payer: Adventist Health Commercial |
$0.61
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.85
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.28
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.47
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
Rate for Payer: Blue Shield of California Commercial |
$1.86
|
Rate for Payer: Blue Shield of California EPN |
$1.21
|
Rate for Payer: Cash Price |
$1.67
|
Rate for Payer: Central Health Plan Commercial |
$2.43
|
Rate for Payer: Cigna of CA HMO |
$2.13
|
Rate for Payer: Cigna of CA PPO |
$2.13
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
Rate for Payer: Dignity Health Medicare Advantage |
$2.58
|
Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
Rate for Payer: EPIC Health Plan Senior |
$1.22
|
Rate for Payer: Galaxy Health WC |
$2.58
|
Rate for Payer: Global Benefits Group Commercial |
$1.82
|
Rate for Payer: Health Management Network EPO/PPO |
$2.74
|
Rate for Payer: InnovAge PACE Commercial |
$1.52
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.13
|
Rate for Payer: Molina Healthcare of CA Medicare |
$2.13
|
Rate for Payer: Multiplan Commercial |
$2.28
|
Rate for Payer: Networks By Design Commercial |
$1.98
|
Rate for Payer: Prime Health Services Commercial |
$2.58
|
Rate for Payer: Riverside University Health System MISP |
$1.22
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
Rate for Payer: United Healthcare All Other Commercial |
$1.52
|
Rate for Payer: United Healthcare All Other HMO |
$1.52
|
Rate for Payer: United Healthcare HMO Rider |
$1.52
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$1.52
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
BUSPIRONE 10 MG TABLET [9323]
|
Facility
|
OP
|
$0.16
|
|
Service Code
|
NDC 51079-986-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
Rate for Payer: Blue Shield of California Commercial |
$0.10
|
Rate for Payer: Blue Shield of California EPN |
$0.06
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Central Health Plan Commercial |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Senior |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
Rate for Payer: InnovAge PACE Commercial |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
Rate for Payer: Multiplan Commercial |
$0.12
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
Rate for Payer: Riverside University Health System MISP |
$0.06
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
Rate for Payer: United Healthcare All Other HMO |
$0.08
|
Rate for Payer: United Healthcare HMO Rider |
$0.08
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
BUSPIRONE 10 MG TABLET [9323]
|
Facility
|
OP
|
$0.05
|
|
Service Code
|
NDC 16729-202-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
Rate for Payer: Blue Shield of California Commercial |
$0.03
|
Rate for Payer: Blue Shield of California EPN |
$0.02
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Central Health Plan Commercial |
$0.04
|
Rate for Payer: Cigna of CA HMO |
$0.04
|
Rate for Payer: Cigna of CA PPO |
$0.04
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: EPIC Health Plan Senior |
$0.02
|
Rate for Payer: Galaxy Health WC |
$0.04
|
Rate for Payer: Global Benefits Group Commercial |
$0.03
|
Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
Rate for Payer: InnovAge PACE Commercial |
$0.03
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.04
|
Rate for Payer: Networks By Design Commercial |
$0.03
|
Rate for Payer: Prime Health Services Commercial |
$0.04
|
Rate for Payer: Riverside University Health System MISP |
$0.02
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
Rate for Payer: United Healthcare All Other HMO |
$0.03
|
Rate for Payer: United Healthcare HMO Rider |
$0.03
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
BUSPIRONE 10 MG TABLET [9323]
|
Facility
|
IP
|
$0.08
|
|
Service Code
|
NDC 29300-245-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Blue Shield of California Commercial |
$0.06
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Central Health Plan Commercial |
$0.06
|
Rate for Payer: Cigna of CA HMO |
$0.06
|
Rate for Payer: Cigna of CA PPO |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: EPIC Health Plan Senior |
$0.03
|
Rate for Payer: Galaxy Health WC |
$0.07
|
Rate for Payer: Global Benefits Group Commercial |
$0.05
|
Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
BUSPIRONE 10 MG TABLET [9323]
|
Facility
|
IP
|
$0.09
|
|
Service Code
|
NDC 68382-181-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.05
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Central Health Plan Commercial |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.06
|
Rate for Payer: Cigna of CA PPO |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Senior |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.08
|
Rate for Payer: Global Benefits Group Commercial |
$0.05
|
Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.07
|
Rate for Payer: Networks By Design Commercial |
$0.06
|
Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
BUSPIRONE 10 MG TABLET [9323]
|
Facility
|
IP
|
$0.16
|
|
Service Code
|
NDC 51079-986-20
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Central Health Plan Commercial |
$0.13
|
Rate for Payer: Cigna of CA HMO |
$0.11
|
Rate for Payer: Cigna of CA PPO |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: EPIC Health Plan Senior |
$0.06
|
Rate for Payer: Galaxy Health WC |
$0.14
|
Rate for Payer: Global Benefits Group Commercial |
$0.10
|
Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.12
|
Rate for Payer: Networks By Design Commercial |
$0.10
|
Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
BUSPIRONE 10 MG TABLET [9323]
|
Facility
|
OP
|
$0.09
|
|
Service Code
|
NDC 68382-181-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.04
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Central Health Plan Commercial |
$0.07
|
Rate for Payer: Cigna of CA HMO |
$0.06
|
Rate for Payer: Cigna of CA PPO |
$0.06
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: EPIC Health Plan Senior |
$0.04
|
Rate for Payer: Galaxy Health WC |
$0.08
|
Rate for Payer: Global Benefits Group Commercial |
$0.05
|
Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
Rate for Payer: InnovAge PACE Commercial |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.07
|
Rate for Payer: Networks By Design Commercial |
$0.06
|
Rate for Payer: Prime Health Services Commercial |
$0.08
|
Rate for Payer: Riverside University Health System MISP |
$0.04
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
Rate for Payer: United Healthcare All Other HMO |
$0.05
|
Rate for Payer: United Healthcare HMO Rider |
$0.05
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
BUSPIRONE 10 MG TABLET [9323]
|
Facility
|
IP
|
$0.05
|
|
Service Code
|
NDC 16729-202-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.05 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Blue Shield of California Commercial |
$0.04
|
Rate for Payer: Blue Shield of California EPN |
$0.03
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: Central Health Plan Commercial |
$0.04
|
Rate for Payer: Cigna of CA HMO |
$0.04
|
Rate for Payer: Cigna of CA PPO |
$0.04
|
Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
Rate for Payer: EPIC Health Plan Senior |
$0.02
|
Rate for Payer: Galaxy Health WC |
$0.04
|
Rate for Payer: Global Benefits Group Commercial |
$0.03
|
Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
Rate for Payer: Multiplan Commercial |
$0.04
|
Rate for Payer: Networks By Design Commercial |
$0.03
|
Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
BUSPIRONE 10 MG TABLET [9323]
|
Facility
|
OP
|
$0.08
|
|
Service Code
|
NDC 29300-245-01
|
Hospital Charge Code |
901700029
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
Rate for Payer: Blue Shield of California Commercial |
$0.05
|
Rate for Payer: Blue Shield of California EPN |
$0.03
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Central Health Plan Commercial |
$0.06
|
Rate for Payer: Cigna of CA HMO |
$0.06
|
Rate for Payer: Cigna of CA PPO |
$0.06
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
Rate for Payer: EPIC Health Plan Senior |
$0.03
|
Rate for Payer: Galaxy Health WC |
$0.07
|
Rate for Payer: Global Benefits Group Commercial |
$0.05
|
Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
Rate for Payer: InnovAge PACE Commercial |
$0.04
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.06
|
Rate for Payer: Networks By Design Commercial |
$0.05
|
Rate for Payer: Prime Health Services Commercial |
$0.07
|
Rate for Payer: Riverside University Health System MISP |
$0.03
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
Rate for Payer: United Healthcare All Other HMO |
$0.04
|
Rate for Payer: United Healthcare HMO Rider |
$0.04
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|