|
MINOCYCLINE 100 MG INTRAVENOUS SOLUTION [10612]
|
Facility
|
OP
|
$325.90
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$293.31 |
| Rate for Payer: Adventist Health Commercial |
$65.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.31
|
| Rate for Payer: Blue Shield of California EPN |
$3.01
|
| Rate for Payer: Cash Price |
$146.66
|
| Rate for Payer: Cash Price |
$146.66
|
| Rate for Payer: Central Health Plan Commercial |
$260.72
|
| Rate for Payer: Cigna of CA HMO |
$228.13
|
| Rate for Payer: Cigna of CA PPO |
$228.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Senior |
$3.01
|
| Rate for Payer: Galaxy Health WC |
$277.01
|
| Rate for Payer: Global Benefits Group Commercial |
$195.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$244.43
|
| Rate for Payer: Networks By Design Commercial |
$162.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.74
|
| Rate for Payer: Prime Health Services Commercial |
$277.01
|
| Rate for Payer: Prime Health Services Medicare |
$2.90
|
| Rate for Payer: Riverside University Health System MISP |
$3.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.31
|
| Rate for Payer: United Healthcare All Other HMO |
$119.05
|
| Rate for Payer: United Healthcare HMO Rider |
$116.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.01
|
| Rate for Payer: Vantage Medical Group Senior |
$3.01
|
|
|
MINOCYCLINE 100 MG INTRAVENOUS SOLUTION [10612]
|
Facility
|
IP
|
$325.90
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$293.31 |
| Rate for Payer: Adventist Health Commercial |
$65.18
|
| Rate for Payer: Blue Shield of California Commercial |
$261.37
|
| Rate for Payer: Blue Shield of California EPN |
$164.25
|
| Rate for Payer: Cash Price |
$146.66
|
| Rate for Payer: Central Health Plan Commercial |
$260.72
|
| Rate for Payer: Cigna of CA HMO |
$228.13
|
| Rate for Payer: Cigna of CA PPO |
$228.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.36
|
| Rate for Payer: EPIC Health Plan Senior |
$130.36
|
| Rate for Payer: Galaxy Health WC |
$277.01
|
| Rate for Payer: Global Benefits Group Commercial |
$195.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$293.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.18
|
| Rate for Payer: Multiplan Commercial |
$244.43
|
| Rate for Payer: Networks By Design Commercial |
$162.95
|
| Rate for Payer: Prime Health Services Commercial |
$277.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.31
|
| Rate for Payer: United Healthcare All Other HMO |
$119.05
|
| Rate for Payer: United Healthcare HMO Rider |
$116.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.73
|
|
|
MINOCYCLINE 50 MG CAPSULE [5111]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 0591569401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
MINOCYCLINE 50 MG CAPSULE [5111]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 0591569401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$40,010.14
|
|
|
Service Code
|
MSDRG 663
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$40,010.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,010.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,844.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,183.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,082.63
|
| Rate for Payer: EPIC Health Plan Senior |
$24,055.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,868.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,615.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,303.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,868.26
|
| Rate for Payer: Prime Health Services Medicare |
$23,180.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$80,575.62
|
|
|
Service Code
|
MSDRG 662
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$80,575.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80,575.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52,048.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72,869.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$71,157.83
|
| Rate for Payer: EPIC Health Plan Senior |
$47,438.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43,125.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60,376.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57,788.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$43,125.96
|
| Rate for Payer: Prime Health Services Medicare |
$45,713.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,553.36
|
|
|
Service Code
|
MSDRG 664
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$27,553.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,553.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,798.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,918.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,311.81
|
| Rate for Payer: EPIC Health Plan Senior |
$16,874.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,340.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,476.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,556.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,340.49
|
| Rate for Payer: Prime Health Services Medicare |
$16,260.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MINOR SKIN DISORDERS WITH MCC
|
Facility
|
IP
|
$39,825.91
|
|
|
Service Code
|
MSDRG 606
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$39,825.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,825.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,725.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,017.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,923.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23,948.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,771.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,480.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,174.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,771.72
|
| Rate for Payer: Prime Health Services Medicare |
$23,078.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
MINOR SKIN DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$23,855.54
|
|
|
Service Code
|
MSDRG 607
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$23,855.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,855.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,409.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,574.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,114.47
|
| Rate for Payer: EPIC Health Plan Senior |
$14,742.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,402.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,763.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,959.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,402.71
|
| Rate for Payer: Prime Health Services Medicare |
$14,206.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC
|
Facility
|
IP
|
$39,602.20
|
|
|
Service Code
|
MSDRG 345
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$39,602.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,602.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,581.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,814.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,729.89
|
| Rate for Payer: EPIC Health Plan Senior |
$23,819.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,654.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,316.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,017.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,654.48
|
| Rate for Payer: Prime Health Services Medicare |
$22,953.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC
|
Facility
|
IP
|
$67,976.71
|
|
|
Service Code
|
MSDRG 344
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$67,976.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67,976.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43,910.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61,475.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,264.12
|
| Rate for Payer: EPIC Health Plan Senior |
$40,176.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,523.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51,133.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48,941.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$36,523.71
|
| Rate for Payer: Prime Health Services Medicare |
$38,715.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,219.60
|
|
|
Service Code
|
MSDRG 346
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$31,219.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,219.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,166.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,233.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,481.85
|
| Rate for Payer: EPIC Health Plan Senior |
$18,987.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,261.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,166.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,130.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,261.73
|
| Rate for Payer: Prime Health Services Medicare |
$18,297.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MINOXIDIL 10 MG TABLET [5114]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
HCPCS S0139
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
|
|
MINOXIDIL 10 MG TABLET [5114]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
HCPCS S0139
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
MINOXIDIL 2.5 MG TABLET [5115]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS S0139
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
MINOXIDIL 2.5 MG TABLET [5115]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
HCPCS S0139
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR [196915]
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
NDC 6818015106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$12.76
|
| Rate for Payer: Blue Shield of California EPN |
$8.02
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: Cigna of CA HMO |
$11.14
|
| Rate for Payer: Cigna of CA PPO |
$11.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR [196915]
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
NDC 7071011593
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.25
|
| Rate for Payer: Blue Shield of California Commercial |
$10.09
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: Cigna of CA HMO |
$11.14
|
| Rate for Payer: Cigna of CA PPO |
$11.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR [196915]
|
Facility
|
OP
|
$18.41
|
|
|
Service Code
|
NDC 0469260130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.71
|
| Rate for Payer: Blue Shield of California Commercial |
$11.67
|
| Rate for Payer: Blue Shield of California EPN |
$7.35
|
| Rate for Payer: Cash Price |
$8.28
|
| Rate for Payer: Central Health Plan Commercial |
$14.73
|
| Rate for Payer: Cigna of CA HMO |
$12.89
|
| Rate for Payer: Cigna of CA PPO |
$12.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.36
|
| Rate for Payer: EPIC Health Plan Senior |
$7.36
|
| Rate for Payer: Galaxy Health WC |
$15.65
|
| Rate for Payer: Global Benefits Group Commercial |
$11.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.89
|
| Rate for Payer: Multiplan Commercial |
$13.81
|
| Rate for Payer: Networks By Design Commercial |
$11.97
|
| Rate for Payer: Prime Health Services Commercial |
$15.65
|
| Rate for Payer: Riverside University Health System MISP |
$7.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.21
|
| Rate for Payer: United Healthcare All Other HMO |
$9.21
|
| Rate for Payer: United Healthcare HMO Rider |
$9.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.65
|
| Rate for Payer: Vantage Medical Group Senior |
$15.65
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR [196915]
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
NDC 6818015106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.25
|
| Rate for Payer: Blue Shield of California Commercial |
$10.09
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: Cigna of CA HMO |
$11.14
|
| Rate for Payer: Cigna of CA PPO |
$11.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR [196915]
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
NDC 7071011593
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$12.76
|
| Rate for Payer: Blue Shield of California EPN |
$8.02
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: Cigna of CA HMO |
$11.14
|
| Rate for Payer: Cigna of CA PPO |
$11.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR [196915]
|
Facility
|
IP
|
$18.41
|
|
|
Service Code
|
NDC 0469260130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$14.76
|
| Rate for Payer: Blue Shield of California EPN |
$9.28
|
| Rate for Payer: Cash Price |
$8.28
|
| Rate for Payer: Central Health Plan Commercial |
$14.73
|
| Rate for Payer: Cigna of CA HMO |
$12.89
|
| Rate for Payer: Cigna of CA PPO |
$12.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.36
|
| Rate for Payer: EPIC Health Plan Senior |
$7.36
|
| Rate for Payer: Galaxy Health WC |
$15.65
|
| Rate for Payer: Global Benefits Group Commercial |
$11.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$13.81
|
| Rate for Payer: Networks By Design Commercial |
$11.97
|
| Rate for Payer: Prime Health Services Commercial |
$15.65
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET [29531]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 5723701106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| 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 |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET [29531]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 5723701106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: Riverside University Health System MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET [29531]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 6586202106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
