|
LOXAPINE SUCCINATE 10 MG CAPSULE [4599]
|
Facility
IP
|
$0.86
|
|
|
Service Code
|
NDC 0591-0370-01
|
| Hospital Charge Code |
1712344
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.73
|
|
|
LUBIPROSTONE 24 MCG CAPSULE [70472]
|
Facility
IP
|
$5.94
|
|
|
Service Code
|
NDC 0254-3029-02
|
| Hospital Charge Code |
1711906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Blue Shield of California Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Central Health Plan Commercial |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$4.16
|
| Rate for Payer: Cigna of CA PPO |
$4.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Galaxy Health WC |
$5.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
| Rate for Payer: Networks By Design Commercial |
$3.86
|
| Rate for Payer: Prime Health Services Commercial |
$5.05
|
|
|
LUBIPROSTONE 24 MCG CAPSULE [70472]
|
Facility
IP
|
$7.42
|
|
|
Service Code
|
NDC 64764-240-60
|
| Hospital Charge Code |
1711906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Blue Shield of California Commercial |
$5.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.96
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Central Health Plan Commercial |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$5.19
|
| Rate for Payer: Cigna of CA PPO |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.31
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.31
|
|
|
LUBIPROSTONE 24 MCG CAPSULE [70472]
|
Facility
IP
|
$2.12
|
|
|
Service Code
|
NDC 0480-4138-06
|
| Hospital Charge Code |
1711906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
|
|
LUBIPROSTONE 24 MCG CAPSULE [70472]
|
Facility
OP
|
$2.12
|
|
|
Service Code
|
NDC 0480-4138-06
|
| Hospital Charge Code |
1711906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: BCBS Transplant Transplant |
$1.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.59
|
| Rate for Payer: IEHP medi-cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: Riverside University Health MISP |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1.80
|
|
|
LUBIPROSTONE 24 MCG CAPSULE [70472]
|
Facility
OP
|
$7.42
|
|
|
Service Code
|
NDC 64764-240-60
|
| Hospital Charge Code |
1711906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.38
|
| Rate for Payer: BCBS Transplant Transplant |
$4.45
|
| Rate for Payer: Blue Shield of California Commercial |
$4.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Central Health Plan Commercial |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$5.19
|
| Rate for Payer: Cigna of CA PPO |
$5.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.31
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.56
|
| Rate for Payer: IEHP medi-cal |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.45
|
| Rate for Payer: Riverside University Health MISP |
$2.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.71
|
| Rate for Payer: United Healthcare All Other HMO |
$3.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Senior |
$6.31
|
|
|
LUBIPROSTONE 24 MCG CAPSULE [70472]
|
Facility
OP
|
$5.94
|
|
|
Service Code
|
NDC 0254-3029-02
|
| Hospital Charge Code |
1711906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.51
|
| Rate for Payer: BCBS Transplant Transplant |
$3.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.90
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Central Health Plan Commercial |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$4.16
|
| Rate for Payer: Cigna of CA PPO |
$4.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.38
|
| Rate for Payer: Galaxy Health WC |
$5.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.46
|
| Rate for Payer: IEHP medi-cal |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
| Rate for Payer: Networks By Design Commercial |
$3.86
|
| Rate for Payer: Prime Health Services Commercial |
$5.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.56
|
| Rate for Payer: Riverside University Health MISP |
$2.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5.05
|
|
|
LUBIPROSTONE 8 MCG CAPSULE [91534]
|
Facility
OP
|
$7.42
|
|
|
Service Code
|
NDC 64764-080-60
|
| Hospital Charge Code |
1712473
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.38
|
| Rate for Payer: BCBS Transplant Transplant |
$4.45
|
| Rate for Payer: Blue Shield of California Commercial |
$4.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Central Health Plan Commercial |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$5.19
|
| Rate for Payer: Cigna of CA PPO |
$5.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.31
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.56
|
| Rate for Payer: IEHP medi-cal |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.45
|
| Rate for Payer: Riverside University Health MISP |
$2.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.71
|
| Rate for Payer: United Healthcare All Other HMO |
$3.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Senior |
$6.31
|
|
|
LUBIPROSTONE 8 MCG CAPSULE [91534]
|
Facility
IP
|
$7.42
|
|
|
Service Code
|
NDC 64764-080-60
|
| Hospital Charge Code |
1712473
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Blue Shield of California Commercial |
$5.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.96
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Central Health Plan Commercial |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$5.19
|
| Rate for Payer: Cigna of CA PPO |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.31
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.31
|
|
|
LURASIDONE 40 MG TABLET [107668]
|
Facility
IP
|
$5.13
|
|
|
Service Code
|
NDC 60687-758-11
|
| Hospital Charge Code |
1712502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.59
|
| Rate for Payer: Cigna of CA PPO |
$3.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.85
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.36
|
|
|
LURASIDONE 40 MG TABLET [107668]
|
Facility
OP
|
$2.13
|
|
|
Service Code
|
NDC 47335-684-83
|
| Hospital Charge Code |
1712502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.26
|
| Rate for Payer: BCBS Transplant Transplant |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.49
|
| Rate for Payer: Cigna of CA PPO |
$1.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.60
|
| Rate for Payer: IEHP medi-cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: Riverside University Health MISP |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1.81
|
|
|
LURASIDONE 40 MG TABLET [107668]
|
Facility
IP
|
$2.13
|
|
|
Service Code
|
NDC 47335-684-83
|
| Hospital Charge Code |
1712502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.49
|
| Rate for Payer: Cigna of CA PPO |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
|
|
LURASIDONE 40 MG TABLET [107668]
|
Facility
IP
|
$5.13
|
|
|
Service Code
|
NDC 60687-758-21
|
| Hospital Charge Code |
1712502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.59
|
| Rate for Payer: Cigna of CA PPO |
$3.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.85
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.36
|
|
|
LURASIDONE 40 MG TABLET [107668]
|
Facility
OP
|
$5.13
|
|
|
Service Code
|
NDC 60687-758-11
|
| Hospital Charge Code |
1712502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.03
|
| Rate for Payer: BCBS Transplant Transplant |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.59
|
| Rate for Payer: Cigna of CA PPO |
$3.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.85
|
| Rate for Payer: IEHP medi-cal |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.85
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.08
|
| Rate for Payer: Riverside University Health MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.36
|
| Rate for Payer: Vantage Medical Group Senior |
$4.36
|
|
|
LURASIDONE 40 MG TABLET [107668]
|
Facility
OP
|
$56.75
|
|
|
Service Code
|
NDC 63402-304-30
|
| Hospital Charge Code |
1712502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.53
|
| Rate for Payer: BCBS Transplant Transplant |
$34.05
|
| Rate for Payer: Blue Shield of California Commercial |
$35.70
|
| Rate for Payer: Blue Shield of California EPN |
$27.75
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Central Health Plan Commercial |
$45.40
|
| Rate for Payer: Cigna of CA HMO |
$39.72
|
| Rate for Payer: Cigna of CA PPO |
$39.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.24
|
| Rate for Payer: Global Benefits Group Commercial |
$34.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$42.56
|
| Rate for Payer: IEHP medi-cal |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Multiplan Commercial |
$42.56
|
| Rate for Payer: Networks By Design Commercial |
$36.89
|
| Rate for Payer: Prime Health Services Commercial |
$48.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$34.05
|
| Rate for Payer: Riverside University Health MISP |
$22.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.38
|
| Rate for Payer: United Healthcare All Other HMO |
$28.38
|
| Rate for Payer: United Healthcare HMO Rider |
$28.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.24
|
| Rate for Payer: Vantage Medical Group Senior |
$48.24
|
|
|
LURASIDONE 40 MG TABLET [107668]
|
Facility
OP
|
$5.13
|
|
|
Service Code
|
NDC 60687-758-21
|
| Hospital Charge Code |
1712502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.03
|
| Rate for Payer: BCBS Transplant Transplant |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.59
|
| Rate for Payer: Cigna of CA PPO |
$3.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.85
|
| Rate for Payer: IEHP medi-cal |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.85
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.08
|
| Rate for Payer: Riverside University Health MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.36
|
| Rate for Payer: Vantage Medical Group Senior |
$4.36
|
|
|
LURASIDONE 40 MG TABLET [107668]
|
Facility
IP
|
$56.75
|
|
|
Service Code
|
NDC 63402-304-30
|
| Hospital Charge Code |
1712502
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Blue Shield of California Commercial |
$42.56
|
| Rate for Payer: Blue Shield of California EPN |
$30.30
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Central Health Plan Commercial |
$45.40
|
| Rate for Payer: Cigna of CA HMO |
$39.72
|
| Rate for Payer: Cigna of CA PPO |
$39.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.24
|
| Rate for Payer: Global Benefits Group Commercial |
$34.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Multiplan Commercial |
$42.56
|
| Rate for Payer: Networks By Design Commercial |
$36.89
|
| Rate for Payer: Prime Health Services Commercial |
$48.24
|
|
|
LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION [228261]
|
Facility
IP
|
$9,396.00
|
|
|
Service Code
|
NDC 68727-712-01
|
| Hospital Charge Code |
ERX408205864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,879.20 |
| Max. Negotiated Rate |
$8,456.40 |
| Rate for Payer: Blue Shield of California Commercial |
$7,047.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,017.46
|
| Rate for Payer: Cash Price |
$4,228.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,516.80
|
| Rate for Payer: Cigna of CA HMO |
$6,577.20
|
| Rate for Payer: Cigna of CA PPO |
$6,577.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,758.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,758.40
|
| Rate for Payer: Galaxy Health WC |
$7,986.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,637.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,456.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,267.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,879.20
|
| Rate for Payer: Multiplan Commercial |
$7,047.00
|
| Rate for Payer: Networks By Design Commercial |
$4,698.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,986.60
|
|
|
LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION [228261]
|
Facility
OP
|
$9,396.00
|
|
|
Service Code
|
NDC 68727-712-01
|
| Hospital Charge Code |
ERX408205864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,879.20 |
| Max. Negotiated Rate |
$8,456.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,706.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,986.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,167.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,167.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,549.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,551.16
|
| Rate for Payer: BCBS Transplant Transplant |
$5,637.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,910.08
|
| Rate for Payer: Blue Shield of California EPN |
$4,594.64
|
| Rate for Payer: Cash Price |
$4,228.20
|
| Rate for Payer: Cash Price |
$4,228.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,516.80
|
| Rate for Payer: Cigna of CA HMO |
$6,577.20
|
| Rate for Payer: Cigna of CA PPO |
$6,577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,986.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,758.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,758.40
|
| Rate for Payer: Galaxy Health WC |
$7,986.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,637.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,456.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,047.00
|
| Rate for Payer: IEHP medi-cal |
$3,288.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,267.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,879.20
|
| Rate for Payer: Multiplan Commercial |
$7,047.00
|
| Rate for Payer: Networks By Design Commercial |
$4,698.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,986.60
|
| Rate for Payer: Riverside University Health MISP |
$3,758.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,637.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,637.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,698.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,698.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,698.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,698.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,986.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7,986.60
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION [225877]
|
Facility
OP
|
$4,559.88
|
|
|
Service Code
|
CPT J0896
|
| Hospital Charge Code |
ERX225877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$4,103.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$39.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$43.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.68
|
| Rate for Payer: BCBS Transplant Transplant |
$2,735.93
|
| Rate for Payer: Blue Shield of California Commercial |
$45.42
|
| Rate for Payer: Blue Shield of California EPN |
$41.29
|
| Rate for Payer: Caremore Medicare Advantage |
$39.97
|
| Rate for Payer: Cash Price |
$2,051.95
|
| Rate for Payer: Cash Price |
$2,051.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,647.90
|
| Rate for Payer: Cigna of CA HMO |
$3,191.92
|
| Rate for Payer: Cigna of CA PPO |
$3,191.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.97
|
| Rate for Payer: Galaxy Health WC |
$3,875.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,735.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,103.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,419.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$65.55
|
| Rate for Payer: IEHP medi-cal |
$65.95
|
| Rate for Payer: IEHP Medicare Advantage |
$39.97
|
| Rate for Payer: Innovage PACE Commercial |
$59.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,041.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$3,419.91
|
| Rate for Payer: Networks By Design Commercial |
$2,279.94
|
| Rate for Payer: Prime Health Services Commercial |
$3,875.90
|
| Rate for Payer: Prime Health Services Medicare |
$42.37
|
| Rate for Payer: Riverside University Health MISP |
$43.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,735.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,735.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,279.94
|
| Rate for Payer: United Healthcare All Other HMO |
$2,279.94
|
| Rate for Payer: United Healthcare HMO Rider |
$2,279.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,279.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.97
|
| Rate for Payer: Vantage Medical Group Senior |
$43.97
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION [225877]
|
Facility
IP
|
$4,559.88
|
|
|
Service Code
|
CPT J0896
|
| Hospital Charge Code |
ERX225877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$911.98 |
| Max. Negotiated Rate |
$4,103.89 |
| Rate for Payer: Blue Shield of California Commercial |
$3,419.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,434.98
|
| Rate for Payer: Cash Price |
$2,051.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,647.90
|
| Rate for Payer: Cigna of CA HMO |
$3,191.92
|
| Rate for Payer: Cigna of CA PPO |
$3,191.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,823.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,823.95
|
| Rate for Payer: Galaxy Health WC |
$3,875.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,735.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,103.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,041.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.98
|
| Rate for Payer: Multiplan Commercial |
$3,419.91
|
| Rate for Payer: Networks By Design Commercial |
$2,279.94
|
| Rate for Payer: Prime Health Services Commercial |
$3,875.90
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION [225879]
|
Facility
IP
|
$13,679.62
|
|
|
Service Code
|
CPT J0896
|
| Hospital Charge Code |
ERX225879
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,735.92 |
| Max. Negotiated Rate |
$12,311.66 |
| Rate for Payer: Blue Shield of California Commercial |
$10,259.72
|
| Rate for Payer: Blue Shield of California EPN |
$7,304.92
|
| Rate for Payer: Cash Price |
$6,155.83
|
| Rate for Payer: Central Health Plan Commercial |
$10,943.70
|
| Rate for Payer: Cigna of CA HMO |
$9,575.73
|
| Rate for Payer: Cigna of CA PPO |
$9,575.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,471.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,471.85
|
| Rate for Payer: Galaxy Health WC |
$11,627.68
|
| Rate for Payer: Global Benefits Group Commercial |
$8,207.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,311.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,124.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,735.92
|
| Rate for Payer: Multiplan Commercial |
$10,259.72
|
| Rate for Payer: Networks By Design Commercial |
$6,839.81
|
| Rate for Payer: Prime Health Services Commercial |
$11,627.68
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION [225879]
|
Facility
OP
|
$13,679.62
|
|
|
Service Code
|
CPT J0896
|
| Hospital Charge Code |
ERX225879
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$12,311.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$39.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$43.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.68
|
| Rate for Payer: BCBS Transplant Transplant |
$8,207.77
|
| Rate for Payer: Blue Shield of California Commercial |
$45.42
|
| Rate for Payer: Blue Shield of California EPN |
$41.29
|
| Rate for Payer: Caremore Medicare Advantage |
$39.97
|
| Rate for Payer: Cash Price |
$6,155.83
|
| Rate for Payer: Cash Price |
$6,155.83
|
| Rate for Payer: Central Health Plan Commercial |
$10,943.70
|
| Rate for Payer: Cigna of CA HMO |
$9,575.73
|
| Rate for Payer: Cigna of CA PPO |
$9,575.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.97
|
| Rate for Payer: Galaxy Health WC |
$11,627.68
|
| Rate for Payer: Global Benefits Group Commercial |
$8,207.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,311.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,259.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$65.55
|
| Rate for Payer: IEHP medi-cal |
$65.95
|
| Rate for Payer: IEHP Medicare Advantage |
$39.97
|
| Rate for Payer: Innovage PACE Commercial |
$59.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,124.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,735.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$10,259.72
|
| Rate for Payer: Networks By Design Commercial |
$6,839.81
|
| Rate for Payer: Prime Health Services Commercial |
$11,627.68
|
| Rate for Payer: Prime Health Services Medicare |
$42.37
|
| Rate for Payer: Riverside University Health MISP |
$43.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,207.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,207.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,839.81
|
| Rate for Payer: United Healthcare All Other HMO |
$6,839.81
|
| Rate for Payer: United Healthcare HMO Rider |
$6,839.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,839.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.97
|
| Rate for Payer: Vantage Medical Group Senior |
$43.97
|
|
|
LUTETIUM LU 177 DOTATATE 10 MCI/ML (370 MBQ/ML) INTRAVENOUS SOLUTION [220890]
|
Facility
OP
|
$58,680.00
|
|
|
Service Code
|
CPT A9513
|
| Hospital Charge Code |
ERX220890
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$380.87 |
| Max. Negotiated Rate |
$52,812.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$380.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$542.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$571.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$418.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$380.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$470.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.64
|
| Rate for Payer: BCBS Transplant Transplant |
$35,208.00
|
| Rate for Payer: Blue Shield of California Commercial |
$36,264.24
|
| Rate for Payer: Blue Shield of California EPN |
$28,518.48
|
| Rate for Payer: Caremore Medicare Advantage |
$380.87
|
| Rate for Payer: Cash Price |
$26,406.00
|
| Rate for Payer: Cash Price |
$26,406.00
|
| Rate for Payer: Central Health Plan Commercial |
$46,944.00
|
| Rate for Payer: Cigna of CA HMO |
$37,555.20
|
| Rate for Payer: Cigna of CA PPO |
$43,423.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$380.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$380.87
|
| Rate for Payer: Galaxy Health WC |
$49,878.00
|
| Rate for Payer: Global Benefits Group Commercial |
$35,208.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$52,812.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44,010.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$624.63
|
| Rate for Payer: IEHP medi-cal |
$628.44
|
| Rate for Payer: IEHP Medicare Advantage |
$380.87
|
| Rate for Payer: Innovage PACE Commercial |
$571.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,139.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$380.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,736.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.37
|
| Rate for Payer: Multiplan Commercial |
$44,010.00
|
| Rate for Payer: Networks By Design Commercial |
$38,142.00
|
| Rate for Payer: Prime Health Services Commercial |
$49,878.00
|
| Rate for Payer: Prime Health Services Medicare |
$403.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35,208.00
|
| Rate for Payer: Riverside University Health MISP |
$418.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,208.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35,208.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,340.00
|
| Rate for Payer: United Healthcare All Other HMO |
$29,340.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29,340.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29,340.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$418.96
|
| Rate for Payer: Vantage Medical Group Senior |
$380.87
|
|
|
LUTETIUM LU 177 DOTATATE 10 MCI/ML (370 MBQ/ML) INTRAVENOUS SOLUTION [220890]
|
Facility
IP
|
$58,680.00
|
|
|
Service Code
|
CPT A9513
|
| Hospital Charge Code |
ERX220890
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$11,736.00 |
| Max. Negotiated Rate |
$52,812.00 |
| Rate for Payer: Blue Shield of California Commercial |
$44,010.00
|
| Rate for Payer: Blue Shield of California EPN |
$31,335.12
|
| Rate for Payer: Cash Price |
$26,406.00
|
| Rate for Payer: Central Health Plan Commercial |
$46,944.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,472.00
|
| Rate for Payer: Galaxy Health WC |
$49,878.00
|
| Rate for Payer: Global Benefits Group Commercial |
$35,208.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$52,812.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,139.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,736.00
|
| Rate for Payer: Multiplan Commercial |
$44,010.00
|
| Rate for Payer: Networks By Design Commercial |
$38,142.00
|
| Rate for Payer: Prime Health Services Commercial |
$49,878.00
|
|
