|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 66689-037-99
|
| Hospital Charge Code |
1716066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 68094-599-62
|
| Hospital Charge Code |
1716066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
OP
|
$0.33
|
|
|
Service Code
|
NDC 0121-0868-05
|
| Hospital Charge Code |
1716066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 0121-0868-40
|
| Hospital Charge Code |
1716066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
OP
|
$7.16
|
|
|
Service Code
|
NDC 0472-0150-15
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.23
|
| Rate for Payer: BCBS Transplant Transplant |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Central Health Plan Commercial |
$5.73
|
| Rate for Payer: Cigna of CA HMO |
$5.01
|
| Rate for Payer: Cigna of CA PPO |
$5.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.37
|
| Rate for Payer: IEHP medi-cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.37
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.30
|
| Rate for Payer: Riverside University Health MISP |
$2.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Vantage Medical Group Senior |
$6.09
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
IP
|
$5.37
|
|
|
Service Code
|
NDC 0168-0081-15
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Blue Shield of California Commercial |
$4.03
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Central Health Plan Commercial |
$4.30
|
| Rate for Payer: Cigna of CA HMO |
$3.76
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.15
|
| Rate for Payer: Galaxy Health WC |
$4.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.03
|
| Rate for Payer: Networks By Design Commercial |
$3.49
|
| Rate for Payer: Prime Health Services Commercial |
$4.56
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 51672-1263-1
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
IP
|
$7.16
|
|
|
Service Code
|
NDC 0472-0150-15
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Blue Shield of California Commercial |
$5.37
|
| Rate for Payer: Blue Shield of California EPN |
$3.82
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Central Health Plan Commercial |
$5.73
|
| Rate for Payer: Cigna of CA HMO |
$5.01
|
| Rate for Payer: Cigna of CA PPO |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.37
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
NDC 68180-545-02
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
OP
|
$1.18
|
|
|
Service Code
|
NDC 51672-1263-2
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.89
|
| Rate for Payer: IEHP medi-cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: Riverside University Health MISP |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
IP
|
$5.10
|
|
|
Service Code
|
NDC 0472-0150-30
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.08
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
OP
|
$1.18
|
|
|
Service Code
|
NDC 68180-545-02
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.89
|
| Rate for Payer: IEHP medi-cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: Riverside University Health MISP |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
NDC 51672-1263-2
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 51672-1263-1
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
| Rate for Payer: IEHP medi-cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: Riverside University Health MISP |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
OP
|
$5.37
|
|
|
Service Code
|
NDC 0168-0081-15
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.17
|
| Rate for Payer: BCBS Transplant Transplant |
$3.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Central Health Plan Commercial |
$4.30
|
| Rate for Payer: Cigna of CA HMO |
$3.76
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.15
|
| Rate for Payer: Galaxy Health WC |
$4.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.03
|
| Rate for Payer: IEHP medi-cal |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.03
|
| Rate for Payer: Networks By Design Commercial |
$3.49
|
| Rate for Payer: Prime Health Services Commercial |
$4.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.22
|
| Rate for Payer: Riverside University Health MISP |
$2.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.56
|
| Rate for Payer: Vantage Medical Group Senior |
$4.56
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
OP
|
$5.10
|
|
|
Service Code
|
NDC 0472-0150-30
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.01
|
| Rate for Payer: BCBS Transplant Transplant |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.08
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.82
|
| Rate for Payer: IEHP medi-cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.82
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: Riverside University Health MISP |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.55
|
| Rate for Payer: United Healthcare All Other HMO |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT [5755]
|
Facility
IP
|
$1.01
|
|
|
Service Code
|
NDC 68462-799-17
|
| Hospital Charge Code |
1743557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Blue Shield of California Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT [5755]
|
Facility
OP
|
$1.01
|
|
|
Service Code
|
NDC 68462-799-17
|
| Hospital Charge Code |
1743557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: BCBS Transplant Transplant |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.76
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Vantage Medical Group Senior |
$0.86
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [204196]
|
Facility
OP
|
$233.26
|
|
|
Service Code
|
CPT J9301
|
| Hospital Charge Code |
NDG204196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$209.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$70.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$87.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.80
|
| Rate for Payer: BCBS Transplant Transplant |
$139.96
|
| Rate for Payer: Blue Shield of California Commercial |
$87.77
|
| Rate for Payer: Blue Shield of California EPN |
$79.79
|
| Rate for Payer: Caremore Medicare Advantage |
$70.34
|
| Rate for Payer: Cash Price |
$104.97
|
| Rate for Payer: Cash Price |
$104.97
|
| Rate for Payer: Central Health Plan Commercial |
$186.61
|
| Rate for Payer: Cigna of CA HMO |
$163.28
|
| Rate for Payer: Cigna of CA PPO |
$163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$70.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.34
|
| Rate for Payer: Galaxy Health WC |
$198.27
|
| Rate for Payer: Global Benefits Group Commercial |
$139.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$174.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$115.36
|
| Rate for Payer: IEHP medi-cal |
$116.06
|
| Rate for Payer: IEHP Medicare Advantage |
$70.34
|
| Rate for Payer: Innovage PACE Commercial |
$105.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.26
|
| Rate for Payer: Multiplan Commercial |
$174.94
|
| Rate for Payer: Networks By Design Commercial |
$116.63
|
| Rate for Payer: Prime Health Services Commercial |
$198.27
|
| Rate for Payer: Prime Health Services Medicare |
$74.56
|
| Rate for Payer: Riverside University Health MISP |
$77.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.63
|
| Rate for Payer: United Healthcare All Other HMO |
$116.63
|
| Rate for Payer: United Healthcare HMO Rider |
$116.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.38
|
| Rate for Payer: Vantage Medical Group Senior |
$70.34
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [204196]
|
Facility
IP
|
$233.26
|
|
|
Service Code
|
CPT J9301
|
| Hospital Charge Code |
NDG204196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$209.93 |
| Rate for Payer: Blue Shield of California Commercial |
$174.94
|
| Rate for Payer: Blue Shield of California EPN |
$124.56
|
| Rate for Payer: Cash Price |
$104.97
|
| Rate for Payer: Central Health Plan Commercial |
$186.61
|
| Rate for Payer: Cigna of CA HMO |
$163.28
|
| Rate for Payer: Cigna of CA PPO |
$163.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.30
|
| Rate for Payer: Galaxy Health WC |
$198.27
|
| Rate for Payer: Global Benefits Group Commercial |
$139.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.65
|
| Rate for Payer: Multiplan Commercial |
$174.94
|
| Rate for Payer: Networks By Design Commercial |
$116.63
|
| Rate for Payer: Prime Health Services Commercial |
$198.27
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION [216963]
|
Facility
OP
|
$2,253.07
|
|
|
Service Code
|
CPT J2350
|
| Hospital Charge Code |
NDG216963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$2,027.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$74.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.41
|
| Rate for Payer: BCBS Transplant Transplant |
$1,351.84
|
| Rate for Payer: Blue Shield of California Commercial |
$71.50
|
| Rate for Payer: Blue Shield of California EPN |
$65.00
|
| Rate for Payer: Caremore Medicare Advantage |
$59.75
|
| Rate for Payer: Cash Price |
$1,013.88
|
| Rate for Payer: Cash Price |
$1,013.88
|
| Rate for Payer: Central Health Plan Commercial |
$1,802.46
|
| Rate for Payer: Cigna of CA HMO |
$1,577.15
|
| Rate for Payer: Cigna of CA PPO |
$1,577.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.75
|
| Rate for Payer: Galaxy Health WC |
$1,915.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,027.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,689.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.99
|
| Rate for Payer: IEHP medi-cal |
$98.59
|
| Rate for Payer: IEHP Medicare Advantage |
$59.75
|
| Rate for Payer: Innovage PACE Commercial |
$89.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.07
|
| Rate for Payer: Multiplan Commercial |
$1,689.80
|
| Rate for Payer: Networks By Design Commercial |
$1,126.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.11
|
| Rate for Payer: Prime Health Services Medicare |
$63.34
|
| Rate for Payer: Riverside University Health MISP |
$65.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,351.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,126.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,126.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,126.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.73
|
| Rate for Payer: Vantage Medical Group Senior |
$59.75
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION [216963]
|
Facility
IP
|
$2,253.07
|
|
|
Service Code
|
CPT J2350
|
| Hospital Charge Code |
NDG216963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$450.61 |
| Max. Negotiated Rate |
$2,027.76 |
| Rate for Payer: Blue Shield of California Commercial |
$1,689.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.14
|
| Rate for Payer: Cash Price |
$1,013.88
|
| Rate for Payer: Central Health Plan Commercial |
$1,802.46
|
| Rate for Payer: Cigna of CA HMO |
$1,577.15
|
| Rate for Payer: Cigna of CA PPO |
$1,577.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$901.23
|
| Rate for Payer: Galaxy Health WC |
$1,915.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,027.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.61
|
| Rate for Payer: Multiplan Commercial |
$1,689.80
|
| Rate for Payer: Networks By Design Commercial |
$1,126.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.11
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]
|
Facility
IP
|
$119.25
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
NDG91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$107.32 |
| Rate for Payer: Blue Shield of California Commercial |
$89.44
|
| Rate for Payer: Blue Shield of California EPN |
$63.68
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Central Health Plan Commercial |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$83.48
|
| Rate for Payer: Cigna of CA PPO |
$83.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.70
|
| Rate for Payer: Galaxy Health WC |
$101.36
|
| Rate for Payer: Global Benefits Group Commercial |
$71.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.85
|
| Rate for Payer: Multiplan Commercial |
$89.44
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$101.36
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]
|
Facility
OP
|
$119.25
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
NDG91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$107.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.69
|
| Rate for Payer: BCBS Transplant Transplant |
$71.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Central Health Plan Commercial |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$83.48
|
| Rate for Payer: Cigna of CA PPO |
$83.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.70
|
| Rate for Payer: Galaxy Health WC |
$101.36
|
| Rate for Payer: Global Benefits Group Commercial |
$71.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$89.44
|
| Rate for Payer: IEHP medi-cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.85
|
| Rate for Payer: Multiplan Commercial |
$89.44
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$101.36
|
| Rate for Payer: Riverside University Health MISP |
$47.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.62
|
| Rate for Payer: United Healthcare All Other HMO |
$59.62
|
| Rate for Payer: United Healthcare HMO Rider |
$59.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.36
|
| Rate for Payer: Vantage Medical Group Senior |
$101.36
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]
|
Facility
OP
|
$7.80
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.69
|
| Rate for Payer: BCBS Transplant Transplant |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.24
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.85
|
| Rate for Payer: IEHP medi-cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.85
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Riverside University Health MISP |
$3.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
