|
CINACALCET 60 MG TABLET [38101]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
NDC 67877-504-30
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.81
|
| Rate for Payer: IEHP medi-cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: Riverside University Health MISP |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
NDC 69097-411-02
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
NDC 69097-411-02
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.81
|
| Rate for Payer: IEHP medi-cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: Riverside University Health MISP |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
CINACALCET 90 MG TABLET [38102]
|
Facility
IP
|
$96.80
|
|
|
Service Code
|
NDC 55513-075-30
|
| Hospital Charge Code |
1712405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$72.60
|
| Rate for Payer: Blue Shield of California EPN |
$51.69
|
| Rate for Payer: Cash Price |
$43.56
|
| Rate for Payer: Cash Price |
$43.56
|
| Rate for Payer: Central Health Plan Commercial |
$77.44
|
| Rate for Payer: Cigna of CA HMO |
$67.76
|
| Rate for Payer: Cigna of CA PPO |
$67.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.72
|
| Rate for Payer: Galaxy Health WC |
$82.28
|
| Rate for Payer: Global Benefits Group Commercial |
$58.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.36
|
| Rate for Payer: Multiplan Commercial |
$72.60
|
| Rate for Payer: Networks By Design Commercial |
$62.92
|
| Rate for Payer: Prime Health Services Commercial |
$82.28
|
|
|
CINACALCET 90 MG TABLET [38102]
|
Facility
OP
|
$96.80
|
|
|
Service Code
|
NDC 55513-075-30
|
| Hospital Charge Code |
1712405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$82.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.19
|
| Rate for Payer: BCBS Transplant Transplant |
$58.08
|
| Rate for Payer: Blue Shield of California Commercial |
$60.89
|
| Rate for Payer: Blue Shield of California EPN |
$47.34
|
| Rate for Payer: Cash Price |
$43.56
|
| Rate for Payer: Central Health Plan Commercial |
$77.44
|
| Rate for Payer: Cigna of CA HMO |
$67.76
|
| Rate for Payer: Cigna of CA PPO |
$67.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.72
|
| Rate for Payer: Galaxy Health WC |
$82.28
|
| Rate for Payer: Global Benefits Group Commercial |
$58.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.60
|
| Rate for Payer: IEHP medi-cal |
$33.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.36
|
| Rate for Payer: Multiplan Commercial |
$72.60
|
| Rate for Payer: Networks By Design Commercial |
$62.92
|
| Rate for Payer: Prime Health Services Commercial |
$82.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$58.08
|
| Rate for Payer: Riverside University Health MISP |
$38.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.40
|
| Rate for Payer: United Healthcare All Other HMO |
$48.40
|
| Rate for Payer: United Healthcare HMO Rider |
$48.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.28
|
| Rate for Payer: Vantage Medical Group Senior |
$82.28
|
|
|
CIPROFLOXACIN 0.2 %-HYDROCORTISONE 1 % EAR DROPS,SUSPENSION [22986]
|
Facility
IP
|
$37.90
|
|
|
Service Code
|
NDC 0065-8531-10
|
| Hospital Charge Code |
1740308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$28.42
|
| Rate for Payer: Blue Shield of California EPN |
$20.24
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Central Health Plan Commercial |
$30.32
|
| Rate for Payer: Cigna of CA HMO |
$26.53
|
| Rate for Payer: Cigna of CA PPO |
$26.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.16
|
| Rate for Payer: Galaxy Health WC |
$32.22
|
| Rate for Payer: Global Benefits Group Commercial |
$22.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Multiplan Commercial |
$28.42
|
| Rate for Payer: Networks By Design Commercial |
$24.64
|
| Rate for Payer: Prime Health Services Commercial |
$32.22
|
|
|
CIPROFLOXACIN 0.2 %-HYDROCORTISONE 1 % EAR DROPS,SUSPENSION [22986]
|
Facility
OP
|
$37.90
|
|
|
Service Code
|
NDC 0065-8531-10
|
| Hospital Charge Code |
1740308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.39
|
| Rate for Payer: BCBS Transplant Transplant |
$22.74
|
| Rate for Payer: Blue Shield of California Commercial |
$23.84
|
| Rate for Payer: Blue Shield of California EPN |
$18.53
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Central Health Plan Commercial |
$30.32
|
| Rate for Payer: Cigna of CA HMO |
$26.53
|
| Rate for Payer: Cigna of CA PPO |
$26.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.16
|
| Rate for Payer: Galaxy Health WC |
$32.22
|
| Rate for Payer: Global Benefits Group Commercial |
$22.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.42
|
| Rate for Payer: IEHP medi-cal |
$13.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Multiplan Commercial |
$28.42
|
| Rate for Payer: Networks By Design Commercial |
$24.64
|
| Rate for Payer: Prime Health Services Commercial |
$32.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.74
|
| Rate for Payer: Riverside University Health MISP |
$15.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.95
|
| Rate for Payer: United Healthcare All Other HMO |
$18.95
|
| Rate for Payer: United Healthcare HMO Rider |
$18.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.22
|
| Rate for Payer: Vantage Medical Group Senior |
$32.22
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
NDC 43598-326-75
|
| Hospital Charge Code |
1740331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$21.00
|
| Rate for Payer: Blue Shield of California EPN |
$14.95
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$19.60
|
| Rate for Payer: Cigna of CA PPO |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
NDC 43598-326-75
|
| Hospital Charge Code |
1740331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.54
|
| Rate for Payer: BCBS Transplant Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.61
|
| Rate for Payer: Blue Shield of California EPN |
$13.69
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$19.60
|
| Rate for Payer: Cigna of CA PPO |
$19.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.00
|
| Rate for Payer: IEHP medi-cal |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: Riverside University Health MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23.80
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
OP
|
$5.04
|
|
|
Service Code
|
NDC 69315-308-02
|
| Hospital Charge Code |
1740265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.98
|
| Rate for Payer: BCBS Transplant Transplant |
$3.02
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.46
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Central Health Plan Commercial |
$4.03
|
| Rate for Payer: Cigna of CA HMO |
$3.53
|
| Rate for Payer: Cigna of CA PPO |
$3.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.02
|
| Rate for Payer: Galaxy Health WC |
$4.28
|
| Rate for Payer: Global Benefits Group Commercial |
$3.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.78
|
| Rate for Payer: IEHP medi-cal |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: Networks By Design Commercial |
$3.28
|
| Rate for Payer: Prime Health Services Commercial |
$4.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.02
|
| Rate for Payer: Riverside University Health MISP |
$2.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
NDC 69315-308-05
|
| Hospital Charge Code |
1740266
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.99
|
| Rate for Payer: BCBS Transplant Transplant |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.52
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: Riverside University Health MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
NDC 69315-308-05
|
| Hospital Charge Code |
1740266
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
NDC 61314-656-05
|
| Hospital Charge Code |
1740266
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
NDC 61314-656-05
|
| Hospital Charge Code |
1740266
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.99
|
| Rate for Payer: BCBS Transplant Transplant |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.52
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: Riverside University Health MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
OP
|
$5.04
|
|
|
Service Code
|
NDC 61314-656-25
|
| Hospital Charge Code |
1740265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.98
|
| Rate for Payer: BCBS Transplant Transplant |
$3.02
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.46
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Central Health Plan Commercial |
$4.03
|
| Rate for Payer: Cigna of CA HMO |
$3.53
|
| Rate for Payer: Cigna of CA PPO |
$3.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.02
|
| Rate for Payer: Galaxy Health WC |
$4.28
|
| Rate for Payer: Global Benefits Group Commercial |
$3.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.78
|
| Rate for Payer: IEHP medi-cal |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: Networks By Design Commercial |
$3.28
|
| Rate for Payer: Prime Health Services Commercial |
$4.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.02
|
| Rate for Payer: Riverside University Health MISP |
$2.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
IP
|
$5.04
|
|
|
Service Code
|
NDC 61314-656-25
|
| Hospital Charge Code |
1740265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.69
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Central Health Plan Commercial |
$4.03
|
| Rate for Payer: Cigna of CA HMO |
$3.53
|
| Rate for Payer: Cigna of CA PPO |
$3.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Galaxy Health WC |
$4.28
|
| Rate for Payer: Global Benefits Group Commercial |
$3.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: Networks By Design Commercial |
$3.28
|
| Rate for Payer: Prime Health Services Commercial |
$4.28
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
IP
|
$5.04
|
|
|
Service Code
|
NDC 69315-308-02
|
| Hospital Charge Code |
1740265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.69
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Central Health Plan Commercial |
$4.03
|
| Rate for Payer: Cigna of CA HMO |
$3.53
|
| Rate for Payer: Cigna of CA PPO |
$3.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.02
|
| Rate for Payer: Galaxy Health WC |
$4.28
|
| Rate for Payer: Global Benefits Group Commercial |
$3.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: Networks By Design Commercial |
$3.28
|
| Rate for Payer: Prime Health Services Commercial |
$4.28
|
|
|
CIPROFLOXACIN 0.3 % EYE OINTMENT [23234]
|
Facility
IP
|
$77.17
|
|
|
Service Code
|
NDC 0078-0841-01
|
| Hospital Charge Code |
1740324
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$57.88
|
| Rate for Payer: Blue Shield of California EPN |
$41.21
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Central Health Plan Commercial |
$61.74
|
| Rate for Payer: Cigna of CA HMO |
$54.02
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.43
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
|
|
CIPROFLOXACIN 0.3 % EYE OINTMENT [23234]
|
Facility
OP
|
$77.17
|
|
|
Service Code
|
NDC 0078-0841-01
|
| Hospital Charge Code |
1740324
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$69.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.59
|
| Rate for Payer: BCBS Transplant Transplant |
$46.30
|
| Rate for Payer: Blue Shield of California Commercial |
$48.54
|
| Rate for Payer: Blue Shield of California EPN |
$37.74
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Central Health Plan Commercial |
$61.74
|
| Rate for Payer: Cigna of CA HMO |
$54.02
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.87
|
| Rate for Payer: Galaxy Health WC |
$65.59
|
| Rate for Payer: Global Benefits Group Commercial |
$46.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.88
|
| Rate for Payer: IEHP medi-cal |
$27.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.43
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
| Rate for Payer: Networks By Design Commercial |
$50.16
|
| Rate for Payer: Prime Health Services Commercial |
$65.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$46.30
|
| Rate for Payer: Riverside University Health MISP |
$30.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.58
|
| Rate for Payer: United Healthcare All Other HMO |
$38.58
|
| Rate for Payer: United Healthcare HMO Rider |
$38.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Vantage Medical Group Senior |
$65.59
|
|
|
CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108130]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
CPT J0744
|
| Hospital Charge Code |
1753414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$28.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.93
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: IEHP medi-cal |
$1.85
|
| Rate for Payer: IEHP medi-cal |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108130]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
CPT J0744
|
| Hospital Charge Code |
1753414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CIPROFLOXACIN 250 MG/5 ML ORAL SUSPENSION [22987]
|
Facility
OP
|
$1.59
|
|
|
Service Code
|
NDC 50419-779-01
|
| Hospital Charge Code |
1715974
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: BCBS Transplant Transplant |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.19
|
| Rate for Payer: IEHP medi-cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: Riverside University Health MISP |
$0.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
|
CIPROFLOXACIN 250 MG/5 ML ORAL SUSPENSION [22987]
|
Facility
IP
|
$1.59
|
|
|
Service Code
|
NDC 50419-779-01
|
| Hospital Charge Code |
1715974
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.19
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.35
|
|
|
CIPROFLOXACIN 250 MG TABLET [25118]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 55111-126-01
|
| Hospital Charge Code |
1711145
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
CIPROFLOXACIN 250 MG TABLET [25118]
|
Facility
OP
|
$0.27
|
|
|
Service Code
|
NDC 65862-076-01
|
| Hospital Charge Code |
1711145
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Riverside University Health MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
