|
MEPIVACAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [4081086]
|
Facility
IP
|
$0.57
|
|
|
Service Code
|
CPT J0670
|
| Hospital Charge Code |
NDC4081086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]
|
Facility
OP
|
$4,033.58
|
|
|
Service Code
|
CPT J2182
|
| Hospital Charge Code |
ERX211796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$3,630.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$30.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.76
|
| Rate for Payer: BCBS Transplant Transplant |
$2,420.15
|
| Rate for Payer: Blue Shield of California Commercial |
$40.58
|
| Rate for Payer: Blue Shield of California EPN |
$36.89
|
| Rate for Payer: Caremore Medicare Advantage |
$30.50
|
| Rate for Payer: Cash Price |
$1,815.11
|
| Rate for Payer: Cash Price |
$1,815.11
|
| Rate for Payer: Central Health Plan Commercial |
$3,226.86
|
| Rate for Payer: Cigna of CA HMO |
$2,823.51
|
| Rate for Payer: Cigna of CA PPO |
$2,823.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.50
|
| Rate for Payer: Galaxy Health WC |
$3,428.54
|
| Rate for Payer: Global Benefits Group Commercial |
$2,420.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,630.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,025.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.03
|
| Rate for Payer: IEHP medi-cal |
$50.33
|
| Rate for Payer: IEHP Medicare Advantage |
$30.50
|
| Rate for Payer: Innovage PACE Commercial |
$45.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,690.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.88
|
| Rate for Payer: Multiplan Commercial |
$3,025.18
|
| Rate for Payer: Networks By Design Commercial |
$2,016.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,428.54
|
| Rate for Payer: Prime Health Services Medicare |
$32.34
|
| Rate for Payer: Riverside University Health MISP |
$33.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,420.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,420.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,016.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2,016.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2,016.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,016.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.56
|
| Rate for Payer: Vantage Medical Group Senior |
$30.50
|
|
|
MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION [211796]
|
Facility
IP
|
$4,033.58
|
|
|
Service Code
|
CPT J2182
|
| Hospital Charge Code |
ERX211796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$806.72 |
| Max. Negotiated Rate |
$3,630.22 |
| Rate for Payer: Blue Shield of California Commercial |
$3,025.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,153.93
|
| Rate for Payer: Cash Price |
$1,815.11
|
| Rate for Payer: Central Health Plan Commercial |
$3,226.86
|
| Rate for Payer: Cigna of CA HMO |
$2,823.51
|
| Rate for Payer: Cigna of CA PPO |
$2,823.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,613.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,613.43
|
| Rate for Payer: Galaxy Health WC |
$3,428.54
|
| Rate for Payer: Global Benefits Group Commercial |
$2,420.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,630.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,690.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.72
|
| Rate for Payer: Multiplan Commercial |
$3,025.18
|
| Rate for Payer: Networks By Design Commercial |
$2,016.79
|
| Rate for Payer: Prime Health Services Commercial |
$3,428.54
|
|
|
MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [206120]
|
Facility
IP
|
$17.20
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
NDG206120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Blue Shield of California Commercial |
$12.90
|
| Rate for Payer: Blue Shield of California EPN |
$9.18
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Central Health Plan Commercial |
$13.76
|
| Rate for Payer: Cigna of CA HMO |
$12.04
|
| Rate for Payer: Cigna of CA PPO |
$12.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.88
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$12.90
|
| Rate for Payer: Networks By Design Commercial |
$8.60
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
|
|
MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION [206120]
|
Facility
OP
|
$17.20
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
NDG206120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.30
|
| Rate for Payer: BCBS Transplant Transplant |
$10.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Cash Price |
$7.74
|
| Rate for Payer: Central Health Plan Commercial |
$13.76
|
| Rate for Payer: Cigna of CA HMO |
$12.04
|
| Rate for Payer: Cigna of CA PPO |
$12.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.88
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.90
|
| Rate for Payer: IEHP medi-cal |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$12.90
|
| Rate for Payer: Networks By Design Commercial |
$8.60
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
| Rate for Payer: Riverside University Health MISP |
$6.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.60
|
| Rate for Payer: United Healthcare All Other HMO |
$8.60
|
| Rate for Payer: United Healthcare HMO Rider |
$8.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.62
|
| Rate for Payer: Vantage Medical Group Senior |
$14.62
|
|
|
MERCAPTOPURINE 25 MG 1/2 TAB [192268]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1712421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
MERCAPTOPURINE 25 MG 1/2 TAB [192268]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1712421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.30
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Riverside University Health MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
MERCAPTOPURINE 50 MG TABLET [10531]
|
Facility
OP
|
$3.80
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1711074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.30
|
| Rate for Payer: BCBS Transplant Transplant |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.04
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.85
|
| Rate for Payer: IEHP medi-cal |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.85
|
| Rate for Payer: Networks By Design Commercial |
$2.47
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.28
|
| Rate for Payer: Riverside University Health MISP |
$1.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.23
|
| Rate for Payer: Vantage Medical Group Senior |
$3.23
|
|
|
MERCAPTOPURINE 50 MG TABLET [10531]
|
Facility
IP
|
$3.80
|
|
|
Service Code
|
CPT S0108
|
| Hospital Charge Code |
1711074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Blue Shield of California Commercial |
$2.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.04
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.23
|
| Rate for Payer: Global Benefits Group Commercial |
$2.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.85
|
| Rate for Payer: Networks By Design Commercial |
$2.47
|
| Rate for Payer: Prime Health Services Commercial |
$3.23
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
ERX17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Blue Shield of California Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.51
|
| Rate for Payer: Blue Shield of California Commercial |
$18.64
|
| Rate for Payer: Blue Shield of California Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.18
|
| Rate for Payer: Blue Shield of California EPN |
$13.27
|
| Rate for Payer: Blue Shield of California EPN |
$11.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.68
|
| Rate for Payer: Blue Shield of California EPN |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$19.22
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$5.52
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.88
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Central Health Plan Commercial |
$17.61
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$17.40
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$15.41
|
| Rate for Payer: Cigna of CA HMO |
$4.83
|
| Rate for Payer: Cigna of CA PPO |
$15.41
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$17.40
|
| Rate for Payer: Cigna of CA PPO |
$4.83
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$18.71
|
| Rate for Payer: Galaxy Health WC |
$5.86
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.51
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$3.45
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$18.71
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$5.86
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]
|
Facility
OP
|
$24.85
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
ERX17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$22.36 |
| 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: Aetna of CA HMO/PPO |
$2.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.39
|
| Rate for Payer: BCBS Transplant Transplant |
$13.21
|
| Rate for Payer: BCBS Transplant Transplant |
$21.60
|
| Rate for Payer: BCBS Transplant Transplant |
$14.91
|
| Rate for Payer: BCBS Transplant Transplant |
$14.40
|
| Rate for Payer: BCBS Transplant Transplant |
$4.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Central Health Plan Commercial |
$5.52
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$17.61
|
| Rate for Payer: Central Health Plan Commercial |
$19.88
|
| Rate for Payer: Cigna of CA HMO |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$15.41
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$17.40
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$4.83
|
| Rate for Payer: Cigna of CA PPO |
$17.40
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$15.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$18.71
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$5.86
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Global Benefits Group Commercial |
$13.21
|
| Rate for Payer: Global Benefits Group Commercial |
$4.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.64
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$16.51
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$3.45
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$18.71
|
| Rate for Payer: Riverside University Health MISP |
$9.94
|
| Rate for Payer: Riverside University Health MISP |
$2.76
|
| Rate for Payer: Riverside University Health MISP |
$8.80
|
| Rate for Payer: Riverside University Health MISP |
$14.40
|
| Rate for Payer: Riverside University Health MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.42
|
| Rate for Payer: United Healthcare All Other HMO |
$11.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.45
|
| Rate for Payer: United Healthcare HMO Rider |
$3.45
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.86
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$21.12
|
| Rate for Payer: Vantage Medical Group Senior |
$18.71
|
| Rate for Payer: Vantage Medical Group Senior |
$5.86
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
1753510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$10.39 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$10.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.39
|
| Rate for Payer: BCBS Transplant Transplant |
$6.60
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: BCBS Transplant Transplant |
$7.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Central Health Plan Commercial |
$9.89
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$8.65
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$8.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.94
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$10.51
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.25
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.47
|
| Rate for Payer: Multiplan Commercial |
$9.27
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Networks By Design Commercial |
$5.50
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Prime Health Services Commercial |
$10.51
|
| Rate for Payer: Riverside University Health MISP |
$4.40
|
| Rate for Payer: Riverside University Health MISP |
$4.80
|
| Rate for Payer: Riverside University Health MISP |
$4.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.18
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.18
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.51
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.51
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
1753510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$6.60
|
| Rate for Payer: Blue Shield of California EPN |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$6.41
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.89
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$8.65
|
| Rate for Payer: Cigna of CA HMO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$8.65
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.94
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$10.51
|
| Rate for Payer: Global Benefits Group Commercial |
$7.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$9.27
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.50
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Prime Health Services Commercial |
$10.51
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]
|
Facility
OP
|
$259.20
|
|
|
Service Code
|
CPT J2186
|
| Hospital Charge Code |
ERX219863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.51
|
| Rate for Payer: BCBS Transplant Transplant |
$155.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2.08
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Central Health Plan Commercial |
$207.36
|
| Rate for Payer: Cigna of CA HMO |
$181.44
|
| Rate for Payer: Cigna of CA PPO |
$181.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$220.32
|
| Rate for Payer: Global Benefits Group Commercial |
$155.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$194.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.40
|
| Rate for Payer: IEHP medi-cal |
$3.43
|
| Rate for Payer: IEHP Medicare Advantage |
$2.08
|
| Rate for Payer: Innovage PACE Commercial |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$220.32
|
| Rate for Payer: Prime Health Services Medicare |
$2.20
|
| Rate for Payer: Riverside University Health MISP |
$2.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Other HMO |
$129.60
|
| Rate for Payer: United Healthcare HMO Rider |
$129.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: Vantage Medical Group Senior |
$2.08
|
|
|
MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]
|
Facility
IP
|
$259.20
|
|
|
Service Code
|
CPT J2186
|
| Hospital Charge Code |
ERX219863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.84 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Blue Shield of California Commercial |
$194.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.41
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Central Health Plan Commercial |
$207.36
|
| Rate for Payer: Cigna of CA HMO |
$181.44
|
| Rate for Payer: Cigna of CA PPO |
$181.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$103.68
|
| Rate for Payer: Galaxy Health WC |
$220.32
|
| Rate for Payer: Global Benefits Group Commercial |
$155.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.84
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$220.32
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-7
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Central Health Plan Commercial |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$19.10
|
|
|
Service Code
|
NDC 0378-9230-93
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.28
|
| Rate for Payer: BCBS Transplant Transplant |
$11.46
|
| Rate for Payer: Blue Shield of California Commercial |
$12.01
|
| Rate for Payer: Blue Shield of California EPN |
$9.34
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Central Health Plan Commercial |
$15.28
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.24
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.32
|
| Rate for Payer: IEHP medi-cal |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.46
|
| Rate for Payer: Riverside University Health MISP |
$7.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.55
|
| Rate for Payer: United Healthcare All Other HMO |
$9.55
|
| Rate for Payer: United Healthcare HMO Rider |
$9.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.24
|
| Rate for Payer: Vantage Medical Group Senior |
$16.24
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$19.10
|
|
|
Service Code
|
NDC 0378-9230-93
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Blue Shield of California Commercial |
$14.32
|
| Rate for Payer: Blue Shield of California EPN |
$10.20
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Central Health Plan Commercial |
$15.28
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.24
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.24
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-7
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.15
|
| Rate for Payer: BCBS Transplant Transplant |
$4.21
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Central Health Plan Commercial |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.26
|
| Rate for Payer: IEHP medi-cal |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: Riverside University Health MISP |
$2.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Vantage Medical Group Senior |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-6
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Central Health Plan Commercial |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$6.77
|
|
|
Service Code
|
NDC 59762-0118-3
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.26
|
| Rate for Payer: Blue Shield of California EPN |
$3.31
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Central Health Plan Commercial |
$5.42
|
| Rate for Payer: Cigna of CA HMO |
$4.74
|
| Rate for Payer: Cigna of CA PPO |
$4.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.71
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.08
|
| Rate for Payer: IEHP medi-cal |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$5.08
|
| Rate for Payer: Networks By Design Commercial |
$4.40
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.06
|
| Rate for Payer: Riverside University Health MISP |
$2.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5.75
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-6
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.15
|
| Rate for Payer: BCBS Transplant Transplant |
$4.21
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Central Health Plan Commercial |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.26
|
| Rate for Payer: IEHP medi-cal |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: Riverside University Health MISP |
$2.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Vantage Medical Group Senior |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$6.77
|
|
|
Service Code
|
NDC 59762-0118-3
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Blue Shield of California Commercial |
$5.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.62
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Central Health Plan Commercial |
$5.42
|
| Rate for Payer: Cigna of CA HMO |
$4.74
|
| Rate for Payer: Cigna of CA PPO |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.71
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$5.08
|
| Rate for Payer: Networks By Design Commercial |
$4.40
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$2.67
|
|
|
Service Code
|
NDC 0378-7401-78
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.58
|
| Rate for Payer: BCBS Transplant Transplant |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Central Health Plan Commercial |
$2.14
|
| Rate for Payer: Cigna of CA HMO |
$1.87
|
| Rate for Payer: Cigna of CA PPO |
$1.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$2.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.00
|
| Rate for Payer: IEHP medi-cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.60
|
| Rate for Payer: Riverside University Health MISP |
$1.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-95
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Blue Shield of California Commercial |
$9.36
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Central Health Plan Commercial |
$9.98
|
| Rate for Payer: Cigna of CA HMO |
$8.74
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.99
|
| Rate for Payer: Galaxy Health WC |
$10.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$9.36
|
| Rate for Payer: Networks By Design Commercial |
$8.11
|
| Rate for Payer: Prime Health Services Commercial |
$10.61
|
|
