|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
NDC 70748-258-07
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Blue Shield of California Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
IP
|
$82.24
|
|
|
Service Code
|
NDC 0085-4324-02
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Blue Shield of California Commercial |
$61.68
|
| Rate for Payer: Blue Shield of California EPN |
$43.92
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Central Health Plan Commercial |
$65.79
|
| Rate for Payer: Cigna of CA HMO |
$57.57
|
| Rate for Payer: Cigna of CA PPO |
$57.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.90
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.45
|
| Rate for Payer: Multiplan Commercial |
$61.68
|
| Rate for Payer: Networks By Design Commercial |
$53.46
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
OP
|
$19.24
|
|
|
Service Code
|
NDC 0527-2133-35
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.37
|
| Rate for Payer: BCBS Transplant Transplant |
$11.54
|
| Rate for Payer: Blue Shield of California Commercial |
$12.10
|
| Rate for Payer: Blue Shield of California EPN |
$9.41
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Central Health Plan Commercial |
$15.39
|
| Rate for Payer: Cigna of CA HMO |
$13.47
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.70
|
| Rate for Payer: Galaxy Health WC |
$16.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.43
|
| Rate for Payer: IEHP medi-cal |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Multiplan Commercial |
$14.43
|
| Rate for Payer: Networks By Design Commercial |
$12.51
|
| Rate for Payer: Prime Health Services Commercial |
$16.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.54
|
| Rate for Payer: Riverside University Health MISP |
$7.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.62
|
| Rate for Payer: United Healthcare All Other HMO |
$9.62
|
| Rate for Payer: United Healthcare HMO Rider |
$9.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16.35
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
IP
|
$56.60
|
|
|
Service Code
|
NDC 60687-523-21
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Blue Shield of California Commercial |
$42.45
|
| Rate for Payer: Blue Shield of California EPN |
$30.22
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Central Health Plan Commercial |
$45.28
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$39.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.11
|
| Rate for Payer: Global Benefits Group Commercial |
$33.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.32
|
| Rate for Payer: Multiplan Commercial |
$42.45
|
| Rate for Payer: Networks By Design Commercial |
$36.79
|
| Rate for Payer: Prime Health Services Commercial |
$48.11
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
OP
|
$56.60
|
|
|
Service Code
|
NDC 60687-523-21
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.44
|
| Rate for Payer: BCBS Transplant Transplant |
$33.96
|
| Rate for Payer: Blue Shield of California Commercial |
$35.60
|
| Rate for Payer: Blue Shield of California EPN |
$27.68
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Central Health Plan Commercial |
$45.28
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$39.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.11
|
| Rate for Payer: Global Benefits Group Commercial |
$33.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$42.45
|
| Rate for Payer: IEHP medi-cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.32
|
| Rate for Payer: Multiplan Commercial |
$42.45
|
| Rate for Payer: Networks By Design Commercial |
$36.79
|
| Rate for Payer: Prime Health Services Commercial |
$48.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.96
|
| Rate for Payer: Riverside University Health MISP |
$22.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.30
|
| Rate for Payer: United Healthcare All Other HMO |
$28.30
|
| Rate for Payer: United Healthcare HMO Rider |
$28.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.11
|
| Rate for Payer: Vantage Medical Group Senior |
$48.11
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
IP
|
$56.60
|
|
|
Service Code
|
NDC 60687-523-11
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Blue Shield of California Commercial |
$42.45
|
| Rate for Payer: Blue Shield of California EPN |
$30.22
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Central Health Plan Commercial |
$45.28
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$39.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.11
|
| Rate for Payer: Global Benefits Group Commercial |
$33.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.32
|
| Rate for Payer: Multiplan Commercial |
$42.45
|
| Rate for Payer: Networks By Design Commercial |
$36.79
|
| Rate for Payer: Prime Health Services Commercial |
$48.11
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
IP
|
$19.24
|
|
|
Service Code
|
NDC 0527-2133-35
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Blue Shield of California Commercial |
$14.43
|
| Rate for Payer: Blue Shield of California EPN |
$10.27
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Central Health Plan Commercial |
$15.39
|
| Rate for Payer: Cigna of CA HMO |
$13.47
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.70
|
| Rate for Payer: Galaxy Health WC |
$16.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Multiplan Commercial |
$14.43
|
| Rate for Payer: Networks By Design Commercial |
$12.51
|
| Rate for Payer: Prime Health Services Commercial |
$16.35
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
NDC 70748-258-07
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.32
|
| Rate for Payer: BCBS Transplant Transplant |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5.66
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.75
|
| Rate for Payer: IEHP medi-cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: Riverside University Health MISP |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
OP
|
$82.24
|
|
|
Service Code
|
NDC 0085-4324-02
|
| Hospital Charge Code |
ERX204306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.59
|
| Rate for Payer: BCBS Transplant Transplant |
$49.34
|
| Rate for Payer: Blue Shield of California Commercial |
$51.73
|
| Rate for Payer: Blue Shield of California EPN |
$40.22
|
| Rate for Payer: Cash Price |
$37.01
|
| Rate for Payer: Central Health Plan Commercial |
$65.79
|
| Rate for Payer: Cigna of CA HMO |
$57.57
|
| Rate for Payer: Cigna of CA PPO |
$57.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.90
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$61.68
|
| Rate for Payer: IEHP medi-cal |
$28.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.45
|
| Rate for Payer: Multiplan Commercial |
$61.68
|
| Rate for Payer: Networks By Design Commercial |
$53.46
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: Riverside University Health MISP |
$32.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.12
|
| Rate for Payer: United Healthcare All Other HMO |
$41.12
|
| Rate for Payer: United Healthcare HMO Rider |
$41.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.90
|
| Rate for Payer: Vantage Medical Group Senior |
$69.90
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [77371]
|
Facility
OP
|
$16.45
|
|
|
Service Code
|
NDC 0085-1328-01
|
| Hospital Charge Code |
1715196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.72
|
| Rate for Payer: BCBS Transplant Transplant |
$9.87
|
| Rate for Payer: Blue Shield of California Commercial |
$10.35
|
| Rate for Payer: Blue Shield of California EPN |
$8.04
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Central Health Plan Commercial |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$11.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.58
|
| Rate for Payer: Galaxy Health WC |
$13.98
|
| Rate for Payer: Global Benefits Group Commercial |
$9.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.34
|
| Rate for Payer: IEHP medi-cal |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$12.34
|
| Rate for Payer: Networks By Design Commercial |
$10.69
|
| Rate for Payer: Prime Health Services Commercial |
$13.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.87
|
| Rate for Payer: Riverside University Health MISP |
$6.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13.98
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION [77371]
|
Facility
IP
|
$16.45
|
|
|
Service Code
|
NDC 0085-1328-01
|
| Hospital Charge Code |
1715196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Blue Shield of California Commercial |
$12.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.78
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Central Health Plan Commercial |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: Galaxy Health WC |
$13.98
|
| Rate for Payer: Global Benefits Group Commercial |
$9.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$12.34
|
| Rate for Payer: Networks By Design Commercial |
$10.69
|
| Rate for Payer: Prime Health Services Commercial |
$13.98
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
OP
|
$38.12
|
|
|
Service Code
|
NDC 0085-4331-01
|
| Hospital Charge Code |
NDG2211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.52
|
| Rate for Payer: BCBS Transplant Transplant |
$22.87
|
| Rate for Payer: Blue Shield of California Commercial |
$23.98
|
| Rate for Payer: Blue Shield of California EPN |
$18.64
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Central Health Plan Commercial |
$30.50
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.59
|
| Rate for Payer: IEHP medi-cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: Multiplan Commercial |
$28.59
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.40
|
| Rate for Payer: Riverside University Health MISP |
$15.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.06
|
| Rate for Payer: United Healthcare All Other HMO |
$19.06
|
| Rate for Payer: United Healthcare HMO Rider |
$19.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.40
|
| Rate for Payer: Vantage Medical Group Senior |
$32.40
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
IP
|
$38.12
|
|
|
Service Code
|
NDC 0085-4331-01
|
| Hospital Charge Code |
NDG2211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Blue Shield of California Commercial |
$28.59
|
| Rate for Payer: Blue Shield of California EPN |
$20.36
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Central Health Plan Commercial |
$30.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: Multiplan Commercial |
$28.59
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.40
|
|
|
Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 57250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,214.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$6,214.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,389.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,214.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,191.89
|
| Rate for Payer: IEHP medi-cal |
$10,254.04
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Innovage PACE Commercial |
$9,321.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,214.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,327.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,327.52
|
| Rate for Payer: Prime Health Services Medicare |
$6,587.44
|
| Rate for Payer: Riverside University Health MISP |
$6,836.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)
|
Facility
OP
|
$7,830.00
|
|
|
Service Code
|
CPT 22840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,830.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure)
|
Facility
OP
|
$8,017.00
|
|
|
Service Code
|
CPT 22842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$8,017.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
IP
|
$49,961.48
|
|
|
Service Code
|
APR-DRG 7114
|
| Min. Negotiated Rate |
$41,925.72 |
| Max. Negotiated Rate |
$49,961.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$41,925.72
|
| Rate for Payer: IEHP medi-cal |
$49,961.48
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
IP
|
$26,605.81
|
|
|
Service Code
|
APR-DRG 7113
|
| Min. Negotiated Rate |
$22,326.55 |
| Max. Negotiated Rate |
$26,605.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,326.55
|
| Rate for Payer: IEHP medi-cal |
$26,605.81
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
IP
|
$16,101.23
|
|
|
Service Code
|
APR-DRG 7112
|
| Min. Negotiated Rate |
$13,511.52 |
| Max. Negotiated Rate |
$16,101.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,511.52
|
| Rate for Payer: IEHP medi-cal |
$16,101.23
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
IP
|
$12,313.19
|
|
|
Service Code
|
APR-DRG 7111
|
| Min. Negotiated Rate |
$10,332.74 |
| Max. Negotiated Rate |
$12,313.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,332.74
|
| Rate for Payer: IEHP medi-cal |
$12,313.19
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
IP
|
$6,561.68
|
|
|
Service Code
|
APR-DRG 7211
|
| Min. Negotiated Rate |
$5,506.31 |
| Max. Negotiated Rate |
$6,561.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,506.31
|
| Rate for Payer: IEHP medi-cal |
$6,561.68
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
IP
|
$24,434.15
|
|
|
Service Code
|
APR-DRG 7214
|
| Min. Negotiated Rate |
$20,504.18 |
| Max. Negotiated Rate |
$24,434.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,504.18
|
| Rate for Payer: IEHP medi-cal |
$24,434.15
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
IP
|
$13,637.27
|
|
|
Service Code
|
APR-DRG 7213
|
| Min. Negotiated Rate |
$11,443.86 |
| Max. Negotiated Rate |
$13,637.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,443.86
|
| Rate for Payer: IEHP medi-cal |
$13,637.27
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
IP
|
$8,646.60
|
|
|
Service Code
|
APR-DRG 7212
|
| Min. Negotiated Rate |
$7,255.88 |
| Max. Negotiated Rate |
$8,646.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,255.88
|
| Rate for Payer: IEHP medi-cal |
$8,646.60
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
IP
|
$2,923.13
|
|
|
Service Code
|
APR-DRG 5611
|
| Min. Negotiated Rate |
$2,452.98 |
| Max. Negotiated Rate |
$2,923.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,452.98
|
| Rate for Payer: IEHP medi-cal |
$2,923.13
|
|
