|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [12329]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 68084-281-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$0.66
|
| Rate for Payer: Cigna of CA PPO |
$0.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.85
|
| Rate for Payer: InnovAge PACE Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
| Rate for Payer: Riverside University Health System MISP |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [12329]
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
NDC 62756-461-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [12329]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 68084-281-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$0.66
|
| Rate for Payer: Cigna of CA PPO |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [12329]
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
NDC 62756-461-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: InnovAge PACE Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [12329]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 51079-978-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: InnovAge PACE Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [12329]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 51079-978-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE [12329]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 51079-978-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: InnovAge PACE Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
CARBIDOPA ER 36.25 MG-LEVODOPA 145 MG CAPSULE,EXTENDED RELEASE [208774]
|
Facility
|
IP
|
$4.99
|
|
|
Service Code
|
NDC 64896-662-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.86
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Central Health Plan Commercial |
$3.99
|
| Rate for Payer: Cigna of CA HMO |
$3.49
|
| Rate for Payer: Cigna of CA PPO |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Networks By Design Commercial |
$3.24
|
| Rate for Payer: Prime Health Services Commercial |
$4.24
|
|
|
CARBIDOPA ER 36.25 MG-LEVODOPA 145 MG CAPSULE,EXTENDED RELEASE [208774]
|
Facility
|
OP
|
$4.99
|
|
|
Service Code
|
NDC 64896-662-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.99
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Central Health Plan Commercial |
$3.99
|
| Rate for Payer: Cigna of CA HMO |
$3.49
|
| Rate for Payer: Cigna of CA PPO |
$3.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.49
|
| Rate for Payer: InnovAge PACE Commercial |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Networks By Design Commercial |
$3.24
|
| Rate for Payer: Prime Health Services Commercial |
$4.24
|
| Rate for Payer: Riverside University Health System MISP |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.24
|
|
|
CARBIDOPA ER 48.75 MG-LEVODOPA 195 MG CAPSULE,EXTENDED RELEASE [208775]
|
Facility
|
IP
|
$4.99
|
|
|
Service Code
|
NDC 64896-663-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.86
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Central Health Plan Commercial |
$3.99
|
| Rate for Payer: Cigna of CA HMO |
$3.49
|
| Rate for Payer: Cigna of CA PPO |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Networks By Design Commercial |
$3.24
|
| Rate for Payer: Prime Health Services Commercial |
$4.24
|
|
|
CARBIDOPA ER 48.75 MG-LEVODOPA 195 MG CAPSULE,EXTENDED RELEASE [208775]
|
Facility
|
OP
|
$4.99
|
|
|
Service Code
|
NDC 64896-663-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.99
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Central Health Plan Commercial |
$3.99
|
| Rate for Payer: Cigna of CA HMO |
$3.49
|
| Rate for Payer: Cigna of CA PPO |
$3.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.49
|
| Rate for Payer: InnovAge PACE Commercial |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Networks By Design Commercial |
$3.24
|
| Rate for Payer: Prime Health Services Commercial |
$4.24
|
| Rate for Payer: Riverside University Health System MISP |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.24
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [9409]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 50228-461-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE [9409]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 50228-461-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: InnovAge PACE Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
CARBIDOPA ER 61.25 MG-LEVODOPA 245 MG CAPSULE,EXTENDED RELEASE [208776]
|
Facility
|
IP
|
$6.26
|
|
|
Service Code
|
NDC 64896-664-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.63 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.16
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Central Health Plan Commercial |
$5.01
|
| Rate for Payer: Cigna of CA HMO |
$4.38
|
| Rate for Payer: Cigna of CA PPO |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$4.07
|
| Rate for Payer: Prime Health Services Commercial |
$5.32
|
|
|
CARBIDOPA ER 61.25 MG-LEVODOPA 245 MG CAPSULE,EXTENDED RELEASE [208776]
|
Facility
|
OP
|
$6.26
|
|
|
Service Code
|
NDC 64896-664-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.63 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.50
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Central Health Plan Commercial |
$5.01
|
| Rate for Payer: Cigna of CA HMO |
$4.38
|
| Rate for Payer: Cigna of CA PPO |
$4.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.63
|
| Rate for Payer: InnovAge PACE Commercial |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$4.07
|
| Rate for Payer: Prime Health Services Commercial |
$5.32
|
| Rate for Payer: Riverside University Health System MISP |
$2.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.13
|
| Rate for Payer: United Healthcare All Other HMO |
$3.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
|
IP
|
$2.18
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Central Health Plan Commercial |
$0.91
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Central Health Plan Commercial |
$1.49
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Central Health Plan Commercial |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$1.85
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.42
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [39265]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$17.24 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Central Health Plan Commercial |
$0.91
|
| Rate for Payer: Central Health Plan Commercial |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Galaxy Health WC |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$1.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: InnovAge PACE Commercial |
$0.87
|
| Rate for Payer: InnovAge PACE Commercial |
$1.08
|
| Rate for Payer: InnovAge PACE Commercial |
$0.63
|
| Rate for Payer: InnovAge PACE Commercial |
$1.09
|
| Rate for Payer: InnovAge PACE Commercial |
$0.93
|
| Rate for Payer: InnovAge PACE Commercial |
$0.50
|
| Rate for Payer: InnovAge PACE Commercial |
$0.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1.00
|
| Rate for Payer: InnovAge PACE Commercial |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Riverside University Health System MISP |
$0.50
|
| Rate for Payer: Riverside University Health System MISP |
$0.87
|
| Rate for Payer: Riverside University Health System MISP |
$0.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Riverside University Health System MISP |
$0.47
|
| Rate for Payer: Riverside University Health System MISP |
$0.74
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Riverside University Health System MISP |
$0.69
|
| Rate for Payer: Riverside University Health System MISP |
$0.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.42
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$0.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.85
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
IP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-58
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Blue Shield of California Commercial |
$295.90
|
| Rate for Payer: Blue Shield of California EPN |
$192.93
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
OP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-58
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.81
|
| Rate for Payer: Blue Shield of California Commercial |
$233.88
|
| Rate for Payer: Blue Shield of California EPN |
$152.73
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: InnovAge PACE Commercial |
$191.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$267.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$267.95
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
| Rate for Payer: Riverside University Health System MISP |
$153.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Vantage Medical Group Senior |
$325.37
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
NDC 81298-5010-3
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$55.66
|
| Rate for Payer: Blue Shield of California EPN |
$36.29
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
IP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-11
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Blue Shield of California Commercial |
$295.90
|
| Rate for Payer: Blue Shield of California EPN |
$192.93
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
OP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-11
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.81
|
| Rate for Payer: Blue Shield of California Commercial |
$233.88
|
| Rate for Payer: Blue Shield of California EPN |
$152.73
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: InnovAge PACE Commercial |
$191.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$267.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$267.95
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
| Rate for Payer: Riverside University Health System MISP |
$153.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Vantage Medical Group Senior |
$325.37
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
NDC 81298-5010-3
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.29
|
| Rate for Payer: Blue Shield of California Commercial |
$43.99
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: InnovAge PACE Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
NDC 81298-5010-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.29
|
| Rate for Payer: Blue Shield of California Commercial |
$43.99
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: InnovAge PACE Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
NDC 81298-5010-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$55.66
|
| Rate for Payer: Blue Shield of California EPN |
$36.29
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
