|
MEXILETINE 150 MG CAPSULE [10595]
|
Facility
|
OP
|
$1.55
|
|
|
Service Code
|
NDC 0093873901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.24
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: Riverside University Health System MISP |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.32
|
|
|
MEXILETINE 150 MG CAPSULE [10595]
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 6068777821
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.30
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Central Health Plan Commercial |
$2.06
|
| Rate for Payer: Cigna of CA HMO |
$1.80
|
| Rate for Payer: Cigna of CA PPO |
$1.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: EPIC Health Plan Senior |
$1.03
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.93
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
|
|
MEXILETINE 150 MG CAPSULE [10595]
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 0527410737
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$0.65
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
| Rate for Payer: Riverside University Health System MISP |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Vantage Medical Group Senior |
$0.79
|
|
|
MEXILETINE 150 MG CAPSULE [10595]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 5074223901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Riverside University Health System MISP |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
MEXILETINE 150 MG CAPSULE [10595]
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 0527410737
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$0.65
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
|
|
MEXILETINE 150 MG CAPSULE [10595]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 6275695501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
MEXILETINE 150 MG CAPSULE [10595]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 6275695501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
MEXILETINE 150 MG CAPSULE [10595]
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 6068777821
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Central Health Plan Commercial |
$2.06
|
| Rate for Payer: Cigna of CA HMO |
$1.80
|
| Rate for Payer: Cigna of CA PPO |
$1.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: EPIC Health Plan Senior |
$1.03
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.93
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
| Rate for Payer: Riverside University Health System MISP |
$1.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2.18
|
|
|
MEXILETINE 200 MG CAPSULE [10596]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 6275695601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Vantage Medical Group Senior |
$0.60
|
|
|
MEXILETINE 200 MG CAPSULE [10596]
|
Facility
|
IP
|
$1.89
|
|
|
Service Code
|
NDC 0093874001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$1.32
|
| Rate for Payer: Cigna of CA PPO |
$1.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
|
|
MEXILETINE 200 MG CAPSULE [10596]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 5074224001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
MEXILETINE 200 MG CAPSULE [10596]
|
Facility
|
OP
|
$1.89
|
|
|
Service Code
|
NDC 0093874001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$1.32
|
| Rate for Payer: Cigna of CA PPO |
$1.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Riverside University Health System MISP |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.61
|
|
|
MEXILETINE 200 MG CAPSULE [10596]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 5074224001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
MEXILETINE 200 MG CAPSULE [10596]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6275695601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.60
|
|
|
MEXILETINE ORAL SUSPENSION COMPOUND 10 MG/ML [4081649]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 9994081649
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
MEXILETINE ORAL SUSPENSION COMPOUND 10 MG/ML [4081649]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 9994081649
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION [41144]
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Blue Shield of California Commercial |
$71.99
|
| Rate for Payer: Blue Shield of California EPN |
$45.24
|
| Rate for Payer: Cash Price |
$40.39
|
| Rate for Payer: Central Health Plan Commercial |
$71.81
|
| Rate for Payer: Cigna of CA HMO |
$62.83
|
| Rate for Payer: Cigna of CA PPO |
$62.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.90
|
| Rate for Payer: EPIC Health Plan Senior |
$35.90
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Multiplan Commercial |
$67.32
|
| Rate for Payer: Networks By Design Commercial |
$44.88
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.69
|
| Rate for Payer: United Healthcare All Other HMO |
$32.79
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.40
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION [41144]
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Adventist Health Commercial |
$22.44
|
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Cash Price |
$50.49
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cash Price |
$50.49
|
| Rate for Payer: Cash Price |
$40.39
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$40.39
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Central Health Plan Commercial |
$89.76
|
| Rate for Payer: Central Health Plan Commercial |
$71.81
|
| Rate for Payer: Central Health Plan Commercial |
$37.44
|
| Rate for Payer: Central Health Plan Commercial |
$26.13
|
| Rate for Payer: Cigna of CA HMO |
$22.86
|
| Rate for Payer: Cigna of CA HMO |
$32.76
|
| Rate for Payer: Cigna of CA HMO |
$62.83
|
| Rate for Payer: Cigna of CA HMO |
$78.54
|
| Rate for Payer: Cigna of CA PPO |
$32.76
|
| Rate for Payer: Cigna of CA PPO |
$62.83
|
| Rate for Payer: Cigna of CA PPO |
$78.54
|
| Rate for Payer: Cigna of CA PPO |
$22.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.88
|
| Rate for Payer: EPIC Health Plan Senior |
$18.72
|
| Rate for Payer: EPIC Health Plan Senior |
$44.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$35.90
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Galaxy Health WC |
$27.76
|
| Rate for Payer: Galaxy Health WC |
$39.78
|
| Rate for Payer: Galaxy Health WC |
$95.37
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Global Benefits Group Commercial |
$19.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$67.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.83
|
| Rate for Payer: Multiplan Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$67.32
|
| Rate for Payer: Multiplan Commercial |
$84.15
|
| Rate for Payer: Networks By Design Commercial |
$44.88
|
| Rate for Payer: Networks By Design Commercial |
$16.33
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: Prime Health Services Commercial |
$39.78
|
| Rate for Payer: Prime Health Services Commercial |
$95.37
|
| Rate for Payer: Prime Health Services Commercial |
$27.76
|
| Rate for Payer: Riverside University Health System MISP |
$44.88
|
| Rate for Payer: Riverside University Health System MISP |
$13.06
|
| Rate for Payer: Riverside University Health System MISP |
$18.72
|
| Rate for Payer: Riverside University Health System MISP |
$35.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.69
|
| Rate for Payer: United Healthcare All Other HMO |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$17.10
|
| Rate for Payer: United Healthcare All Other HMO |
$40.99
|
| Rate for Payer: United Healthcare All Other HMO |
$11.93
|
| Rate for Payer: United Healthcare HMO Rider |
$16.73
|
| Rate for Payer: United Healthcare HMO Rider |
$40.10
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.76
|
| Rate for Payer: Vantage Medical Group Senior |
$76.30
|
| Rate for Payer: Vantage Medical Group Senior |
$27.76
|
| Rate for Payer: Vantage Medical Group Senior |
$39.78
|
| Rate for Payer: Vantage Medical Group Senior |
$95.37
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION [41144]
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$40.39
|
| Rate for Payer: Cash Price |
$40.39
|
| Rate for Payer: Central Health Plan Commercial |
$71.81
|
| Rate for Payer: Cigna of CA HMO |
$62.83
|
| Rate for Payer: Cigna of CA PPO |
$62.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.90
|
| Rate for Payer: EPIC Health Plan Senior |
$35.90
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.83
|
| Rate for Payer: Multiplan Commercial |
$67.32
|
| Rate for Payer: Networks By Design Commercial |
$44.88
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: Riverside University Health System MISP |
$35.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.69
|
| Rate for Payer: United Healthcare All Other HMO |
$32.79
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.30
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION [41144]
|
Facility
|
IP
|
$32.66
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.39 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Adventist Health Commercial |
$22.44
|
| Rate for Payer: Blue Shield of California Commercial |
$26.19
|
| Rate for Payer: Blue Shield of California Commercial |
$89.98
|
| Rate for Payer: Blue Shield of California Commercial |
$71.99
|
| Rate for Payer: Blue Shield of California Commercial |
$37.53
|
| Rate for Payer: Blue Shield of California EPN |
$16.46
|
| Rate for Payer: Blue Shield of California EPN |
$56.55
|
| Rate for Payer: Blue Shield of California EPN |
$23.59
|
| Rate for Payer: Blue Shield of California EPN |
$45.24
|
| Rate for Payer: Cash Price |
$40.39
|
| Rate for Payer: Cash Price |
$50.49
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Central Health Plan Commercial |
$71.81
|
| Rate for Payer: Central Health Plan Commercial |
$26.13
|
| Rate for Payer: Central Health Plan Commercial |
$89.76
|
| Rate for Payer: Central Health Plan Commercial |
$37.44
|
| Rate for Payer: Cigna of CA HMO |
$22.86
|
| Rate for Payer: Cigna of CA HMO |
$32.76
|
| Rate for Payer: Cigna of CA HMO |
$62.83
|
| Rate for Payer: Cigna of CA HMO |
$78.54
|
| Rate for Payer: Cigna of CA PPO |
$78.54
|
| Rate for Payer: Cigna of CA PPO |
$22.86
|
| Rate for Payer: Cigna of CA PPO |
$32.76
|
| Rate for Payer: Cigna of CA PPO |
$62.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$18.72
|
| Rate for Payer: EPIC Health Plan Senior |
$35.90
|
| Rate for Payer: EPIC Health Plan Senior |
$44.88
|
| Rate for Payer: Galaxy Health WC |
$39.78
|
| Rate for Payer: Galaxy Health WC |
$95.37
|
| Rate for Payer: Galaxy Health WC |
$27.76
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Global Benefits Group Commercial |
$19.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$67.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$67.32
|
| Rate for Payer: Multiplan Commercial |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$84.15
|
| Rate for Payer: Multiplan Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$44.88
|
| Rate for Payer: Networks By Design Commercial |
$56.10
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$16.33
|
| Rate for Payer: Prime Health Services Commercial |
$39.78
|
| Rate for Payer: Prime Health Services Commercial |
$27.76
|
| Rate for Payer: Prime Health Services Commercial |
$95.37
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.26
|
| Rate for Payer: United Healthcare All Other HMO |
$11.93
|
| Rate for Payer: United Healthcare All Other HMO |
$40.99
|
| Rate for Payer: United Healthcare All Other HMO |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$17.10
|
| Rate for Payer: United Healthcare HMO Rider |
$40.10
|
| Rate for Payer: United Healthcare HMO Rider |
$16.73
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.33
|
|
|
MICONAZOLE NITRATE 200 MG-2 % (9 GRAM) VAGINAL KIT [24855]
|
Facility
|
OP
|
$9.82
|
|
|
Service Code
|
NDC 2438560602
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6.23
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$6.87
|
| Rate for Payer: Cigna of CA PPO |
$6.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$8.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.87
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Commercial |
$8.35
|
| Rate for Payer: Riverside University Health System MISP |
$3.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.91
|
| Rate for Payer: United Healthcare All Other HMO |
$4.91
|
| Rate for Payer: United Healthcare HMO Rider |
$4.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.35
|
| Rate for Payer: Vantage Medical Group Senior |
$8.35
|
|
|
MICONAZOLE NITRATE 200 MG-2 % (9 GRAM) VAGINAL KIT [24855]
|
Facility
|
IP
|
$9.82
|
|
|
Service Code
|
NDC 2438560602
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$7.88
|
| Rate for Payer: Blue Shield of California EPN |
$4.95
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$6.87
|
| Rate for Payer: Cigna of CA PPO |
$6.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$8.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Commercial |
$8.35
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY [111721]
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 0472173803
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$15.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.63
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Central Health Plan Commercial |
$15.28
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: EPIC Health Plan Senior |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.23
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$16.23
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY [111721]
|
Facility
|
OP
|
$19.10
|
|
|
Service Code
|
NDC 0472173803
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.11
|
| Rate for Payer: Blue Shield of California Commercial |
$12.11
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Central Health Plan Commercial |
$15.28
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: EPIC Health Plan Senior |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.23
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$16.23
|
| Rate for Payer: Riverside University Health System MISP |
$7.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.55
|
| Rate for Payer: United Healthcare All Other HMO |
$9.55
|
| Rate for Payer: United Healthcare HMO Rider |
$9.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.23
|
| Rate for Payer: Vantage Medical Group Senior |
$16.23
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 6126973556
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
