|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 68180-445-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: InnovAge PACE Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 16729-145-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| 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 |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| 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 |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 29300-147-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 16729-145-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: InnovAge PACE Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 67877-242-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 67877-242-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 68180-445-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]
|
Facility
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 53489-141-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.11
|
| Rate for Payer: Blue Shield of California Commercial |
$5.32
|
| Rate for Payer: Blue Shield of California EPN |
$3.47
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Central Health Plan Commercial |
$6.96
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.83
|
| Rate for Payer: InnovAge PACE Commercial |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.09
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
| Rate for Payer: Riverside University Health System MISP |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other HMO |
$4.35
|
| Rate for Payer: United Healthcare HMO Rider |
$4.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.39
|
| Rate for Payer: Vantage Medical Group Senior |
$7.39
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]
|
Facility
|
IP
|
$8.70
|
|
|
Service Code
|
NDC 53489-141-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.38
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Central Health Plan Commercial |
$6.96
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
|
|
QUININE 324 MG CAPSULE [117183]
|
Facility
|
IP
|
$7.86
|
|
|
Service Code
|
NDC 13310-153-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.96
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$5.50
|
| Rate for Payer: Cigna of CA PPO |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Senior |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$6.68
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$5.89
|
| Rate for Payer: Networks By Design Commercial |
$5.11
|
| Rate for Payer: Prime Health Services Commercial |
$6.68
|
|
|
QUININE 324 MG CAPSULE [117183]
|
Facility
|
OP
|
$7.86
|
|
|
Service Code
|
NDC 13310-153-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$5.50
|
| Rate for Payer: Cigna of CA PPO |
$5.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Senior |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$6.68
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.07
|
| Rate for Payer: InnovAge PACE Commercial |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$5.89
|
| Rate for Payer: Networks By Design Commercial |
$5.11
|
| Rate for Payer: Prime Health Services Commercial |
$6.68
|
| Rate for Payer: Riverside University Health System MISP |
$3.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]
|
Facility
|
OP
|
$447.37
|
|
|
Service Code
|
HCPCS 90377
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$484.46 |
| Rate for Payer: Adventist Health Commercial |
$89.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$237.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$271.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$216.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.74
|
| Rate for Payer: Blue Shield of California Commercial |
$273.34
|
| Rate for Payer: Blue Shield of California EPN |
$178.50
|
| Rate for Payer: Cash Price |
$246.05
|
| Rate for Payer: Cash Price |
$246.05
|
| Rate for Payer: Central Health Plan Commercial |
$357.90
|
| Rate for Payer: Cigna of CA HMO |
$313.16
|
| Rate for Payer: Cigna of CA PPO |
$313.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.08
|
| Rate for Payer: EPIC Health Plan Senior |
$237.10
|
| Rate for Payer: Galaxy Health WC |
$380.26
|
| Rate for Payer: Global Benefits Group Commercial |
$268.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$402.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$388.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$237.10
|
| Rate for Payer: InnovAge PACE Commercial |
$355.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.71
|
| Rate for Payer: Multiplan Commercial |
$335.53
|
| Rate for Payer: Networks By Design Commercial |
$223.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$237.10
|
| Rate for Payer: Prime Health Services Commercial |
$380.26
|
| Rate for Payer: Prime Health Services Medicare |
$251.33
|
| Rate for Payer: Riverside University Health System MISP |
$260.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.90
|
| Rate for Payer: United Healthcare All Other HMO |
$163.42
|
| Rate for Payer: United Healthcare HMO Rider |
$159.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$237.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.81
|
| Rate for Payer: Vantage Medical Group Senior |
$260.81
|
|
|
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]
|
Facility
|
IP
|
$447.37
|
|
|
Service Code
|
HCPCS 90377
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$402.63 |
| Rate for Payer: Adventist Health Commercial |
$89.47
|
| Rate for Payer: Blue Shield of California Commercial |
$345.82
|
| Rate for Payer: Blue Shield of California EPN |
$225.47
|
| Rate for Payer: Cash Price |
$246.05
|
| Rate for Payer: Central Health Plan Commercial |
$357.90
|
| Rate for Payer: Cigna of CA HMO |
$313.16
|
| Rate for Payer: Cigna of CA PPO |
$313.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.95
|
| Rate for Payer: EPIC Health Plan Senior |
$178.95
|
| Rate for Payer: Galaxy Health WC |
$380.26
|
| Rate for Payer: Global Benefits Group Commercial |
$268.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$402.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$276.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.47
|
| Rate for Payer: Multiplan Commercial |
$335.53
|
| Rate for Payer: Networks By Design Commercial |
$223.69
|
| Rate for Payer: Prime Health Services Commercial |
$380.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.90
|
| Rate for Payer: United Healthcare All Other HMO |
$163.42
|
| Rate for Payer: United Healthcare HMO Rider |
$159.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.51
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
IP
|
$816.60
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.32 |
| Max. Negotiated Rate |
$734.94 |
| Rate for Payer: Adventist Health Commercial |
$163.32
|
| Rate for Payer: Blue Shield of California Commercial |
$631.23
|
| Rate for Payer: Blue Shield of California EPN |
$411.57
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Central Health Plan Commercial |
$653.28
|
| Rate for Payer: Cigna of CA HMO |
$571.62
|
| Rate for Payer: Cigna of CA PPO |
$571.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.64
|
| Rate for Payer: EPIC Health Plan Senior |
$326.64
|
| Rate for Payer: Galaxy Health WC |
$694.11
|
| Rate for Payer: Global Benefits Group Commercial |
$489.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$734.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$505.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.32
|
| Rate for Payer: Multiplan Commercial |
$612.45
|
| Rate for Payer: Networks By Design Commercial |
$408.30
|
| Rate for Payer: Prime Health Services Commercial |
$694.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.47
|
| Rate for Payer: United Healthcare All Other HMO |
$298.30
|
| Rate for Payer: United Healthcare HMO Rider |
$291.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.44
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
OP
|
$816.60
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.32 |
| Max. Negotiated Rate |
$737.14 |
| Rate for Payer: Adventist Health Commercial |
$163.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$266.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$495.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$333.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$293.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$737.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.23
|
| Rate for Payer: Blue Shield of California Commercial |
$442.49
|
| Rate for Payer: Blue Shield of California EPN |
$402.26
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Central Health Plan Commercial |
$653.28
|
| Rate for Payer: Cigna of CA HMO |
$571.62
|
| Rate for Payer: Cigna of CA PPO |
$571.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$333.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$293.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.69
|
| Rate for Payer: EPIC Health Plan Senior |
$266.44
|
| Rate for Payer: Galaxy Health WC |
$694.11
|
| Rate for Payer: Global Benefits Group Commercial |
$489.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$734.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$436.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.44
|
| Rate for Payer: InnovAge PACE Commercial |
$399.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$544.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.02
|
| Rate for Payer: Multiplan Commercial |
$612.45
|
| Rate for Payer: Networks By Design Commercial |
$408.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$266.44
|
| Rate for Payer: Prime Health Services Commercial |
$694.11
|
| Rate for Payer: Prime Health Services Medicare |
$282.42
|
| Rate for Payer: Riverside University Health System MISP |
$293.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$489.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$489.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.47
|
| Rate for Payer: United Healthcare All Other HMO |
$298.30
|
| Rate for Payer: United Healthcare HMO Rider |
$291.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$266.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$333.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.08
|
| Rate for Payer: Vantage Medical Group Senior |
$293.08
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
IP
|
$520.57
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.11 |
| Max. Negotiated Rate |
$468.51 |
| Rate for Payer: Adventist Health Commercial |
$104.11
|
| Rate for Payer: Blue Shield of California Commercial |
$402.40
|
| Rate for Payer: Blue Shield of California EPN |
$262.37
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Central Health Plan Commercial |
$416.46
|
| Rate for Payer: Cigna of CA HMO |
$364.40
|
| Rate for Payer: Cigna of CA PPO |
$364.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.23
|
| Rate for Payer: EPIC Health Plan Senior |
$208.23
|
| Rate for Payer: Galaxy Health WC |
$442.48
|
| Rate for Payer: Global Benefits Group Commercial |
$312.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.11
|
| Rate for Payer: Multiplan Commercial |
$390.43
|
| Rate for Payer: Networks By Design Commercial |
$260.29
|
| Rate for Payer: Prime Health Services Commercial |
$442.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.37
|
| Rate for Payer: United Healthcare All Other HMO |
$190.16
|
| Rate for Payer: United Healthcare HMO Rider |
$186.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.49
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
OP
|
$520.57
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.11 |
| Max. Negotiated Rate |
$910.18 |
| Rate for Payer: Adventist Health Commercial |
$104.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$312.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$316.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$343.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$910.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.34
|
| Rate for Payer: Blue Shield of California Commercial |
$546.36
|
| Rate for Payer: Blue Shield of California EPN |
$496.69
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Central Health Plan Commercial |
$416.46
|
| Rate for Payer: Cigna of CA HMO |
$364.40
|
| Rate for Payer: Cigna of CA PPO |
$364.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.24
|
| Rate for Payer: EPIC Health Plan Senior |
$312.03
|
| Rate for Payer: Galaxy Health WC |
$442.48
|
| Rate for Payer: Global Benefits Group Commercial |
$312.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$511.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$317.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$312.03
|
| Rate for Payer: InnovAge PACE Commercial |
$468.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$418.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$418.12
|
| Rate for Payer: Multiplan Commercial |
$390.43
|
| Rate for Payer: Networks By Design Commercial |
$260.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$312.03
|
| Rate for Payer: Prime Health Services Commercial |
$442.48
|
| Rate for Payer: Prime Health Services Medicare |
$330.75
|
| Rate for Payer: Riverside University Health System MISP |
$343.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.37
|
| Rate for Payer: United Healthcare All Other HMO |
$190.16
|
| Rate for Payer: United Healthcare HMO Rider |
$186.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$312.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.23
|
| Rate for Payer: Vantage Medical Group Senior |
$343.23
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
IP
|
$521.53
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.31 |
| Max. Negotiated Rate |
$469.38 |
| Rate for Payer: Adventist Health Commercial |
$104.31
|
| Rate for Payer: Blue Shield of California Commercial |
$403.14
|
| Rate for Payer: Blue Shield of California EPN |
$262.85
|
| Rate for Payer: Cash Price |
$286.84
|
| Rate for Payer: Central Health Plan Commercial |
$417.22
|
| Rate for Payer: Cigna of CA HMO |
$365.07
|
| Rate for Payer: Cigna of CA PPO |
$365.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.61
|
| Rate for Payer: EPIC Health Plan Senior |
$208.61
|
| Rate for Payer: Galaxy Health WC |
$443.30
|
| Rate for Payer: Global Benefits Group Commercial |
$312.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$322.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.31
|
| Rate for Payer: Multiplan Commercial |
$391.15
|
| Rate for Payer: Networks By Design Commercial |
$260.76
|
| Rate for Payer: Prime Health Services Commercial |
$443.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.73
|
| Rate for Payer: United Healthcare All Other HMO |
$190.51
|
| Rate for Payer: United Healthcare HMO Rider |
$186.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.80
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
OP
|
$521.53
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.31 |
| Max. Negotiated Rate |
$910.18 |
| Rate for Payer: Adventist Health Commercial |
$104.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$312.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$316.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$343.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$910.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.34
|
| Rate for Payer: Blue Shield of California Commercial |
$546.36
|
| Rate for Payer: Blue Shield of California EPN |
$496.69
|
| Rate for Payer: Cash Price |
$286.84
|
| Rate for Payer: Cash Price |
$286.84
|
| Rate for Payer: Central Health Plan Commercial |
$417.22
|
| Rate for Payer: Cigna of CA HMO |
$365.07
|
| Rate for Payer: Cigna of CA PPO |
$365.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.24
|
| Rate for Payer: EPIC Health Plan Senior |
$312.03
|
| Rate for Payer: Galaxy Health WC |
$443.30
|
| Rate for Payer: Global Benefits Group Commercial |
$312.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$511.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$317.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$312.03
|
| Rate for Payer: InnovAge PACE Commercial |
$468.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$347.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$418.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$418.12
|
| Rate for Payer: Multiplan Commercial |
$391.15
|
| Rate for Payer: Networks By Design Commercial |
$260.76
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$312.03
|
| Rate for Payer: Prime Health Services Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Medicare |
$330.75
|
| Rate for Payer: Riverside University Health System MISP |
$343.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.73
|
| Rate for Payer: United Healthcare All Other HMO |
$190.51
|
| Rate for Payer: United Healthcare HMO Rider |
$186.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$312.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.23
|
| Rate for Payer: Vantage Medical Group Senior |
$343.23
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| 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: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.92
|
| 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: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.92
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| 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
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE [21381]
|
Facility
|
OP
|
$119.88
|
|
|
Service Code
|
HCPCS A9698
|
| Hospital Charge Code |
901700042
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$107.89 |
| Rate for Payer: Adventist Health Commercial |
$23.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.41
|
| Rate for Payer: Blue Shield of California Commercial |
$73.25
|
| Rate for Payer: Blue Shield of California EPN |
$47.83
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: Central Health Plan Commercial |
$95.90
|
| Rate for Payer: Cigna of CA HMO |
$76.72
|
| Rate for Payer: Cigna of CA PPO |
$88.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Senior |
$47.95
|
| Rate for Payer: Galaxy Health WC |
$101.90
|
| Rate for Payer: Global Benefits Group Commercial |
$71.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.89
|
| Rate for Payer: InnovAge PACE Commercial |
$59.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.92
|
| Rate for Payer: Multiplan Commercial |
$89.91
|
| Rate for Payer: Networks By Design Commercial |
$77.92
|
| Rate for Payer: Prime Health Services Commercial |
$101.90
|
| Rate for Payer: Riverside University Health System MISP |
$47.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.94
|
| Rate for Payer: United Healthcare All Other HMO |
$59.94
|
| Rate for Payer: United Healthcare HMO Rider |
$59.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.90
|
| Rate for Payer: Vantage Medical Group Senior |
$101.90
|
|
