|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0600053772
|
| 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
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0600053772
|
| 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
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0600053797
|
| 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
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0600053797
|
| 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
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 45802-974-26
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 45802-974-26
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
|
OP
|
$20.08
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Adventist Health Commercial |
$4.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$78.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$178.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.81
|
| Rate for Payer: Blue Shield of California Commercial |
$106.14
|
| Rate for Payer: Blue Shield of California EPN |
$96.49
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Central Health Plan Commercial |
$16.06
|
| Rate for Payer: Cigna of CA HMO |
$14.06
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.93
|
| Rate for Payer: EPIC Health Plan Senior |
$78.47
|
| Rate for Payer: Galaxy Health WC |
$17.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78.47
|
| Rate for Payer: InnovAge PACE Commercial |
$117.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.15
|
| Rate for Payer: Multiplan Commercial |
$15.06
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$78.47
|
| Rate for Payer: Prime Health Services Commercial |
$17.07
|
| Rate for Payer: Prime Health Services Medicare |
$83.18
|
| Rate for Payer: Riverside University Health System MISP |
$86.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.54
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$78.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.31
|
| Rate for Payer: Vantage Medical Group Senior |
$86.31
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
|
IP
|
$20.08
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Adventist Health Commercial |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.52
|
| Rate for Payer: Blue Shield of California EPN |
$10.12
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Central Health Plan Commercial |
$16.06
|
| Rate for Payer: Cigna of CA HMO |
$14.06
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.03
|
| Rate for Payer: EPIC Health Plan Senior |
$8.03
|
| Rate for Payer: Galaxy Health WC |
$17.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$15.06
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: Prime Health Services Commercial |
$17.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.54
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.58
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
OP
|
$20.08
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Adventist Health Commercial |
$4.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$78.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$178.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.81
|
| Rate for Payer: Blue Shield of California Commercial |
$106.14
|
| Rate for Payer: Blue Shield of California EPN |
$96.49
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Central Health Plan Commercial |
$16.06
|
| Rate for Payer: Cigna of CA HMO |
$14.06
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.93
|
| Rate for Payer: EPIC Health Plan Senior |
$78.47
|
| Rate for Payer: Galaxy Health WC |
$17.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78.47
|
| Rate for Payer: InnovAge PACE Commercial |
$117.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.15
|
| Rate for Payer: Multiplan Commercial |
$15.06
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$78.47
|
| Rate for Payer: Prime Health Services Commercial |
$17.07
|
| Rate for Payer: Prime Health Services Medicare |
$83.18
|
| Rate for Payer: Riverside University Health System MISP |
$86.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.54
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$78.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.31
|
| Rate for Payer: Vantage Medical Group Senior |
$86.31
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
|
IP
|
$20.08
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Adventist Health Commercial |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.52
|
| Rate for Payer: Blue Shield of California EPN |
$10.12
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Central Health Plan Commercial |
$16.06
|
| Rate for Payer: Cigna of CA HMO |
$14.06
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.03
|
| Rate for Payer: EPIC Health Plan Senior |
$8.03
|
| Rate for Payer: Galaxy Health WC |
$17.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$15.06
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: Prime Health Services Commercial |
$17.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.54
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.58
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID [1562]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0395266216
|
| 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
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID [1562]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0395266216
|
| 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
|
|
|
CHLORAMPHENICOL SODIUM SUCCINATE 1 GRAM INTRAVENOUS SOLUTION [25518]
|
Facility
|
IP
|
$58.38
|
|
|
Service Code
|
HCPCS J0720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$52.54 |
| Rate for Payer: Adventist Health Commercial |
$11.68
|
| Rate for Payer: Blue Shield of California Commercial |
$45.13
|
| Rate for Payer: Blue Shield of California EPN |
$29.42
|
| Rate for Payer: Cash Price |
$32.11
|
| Rate for Payer: Central Health Plan Commercial |
$46.70
|
| Rate for Payer: Cigna of CA HMO |
$40.87
|
| Rate for Payer: Cigna of CA PPO |
$40.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.35
|
| Rate for Payer: EPIC Health Plan Senior |
$23.35
|
| Rate for Payer: Galaxy Health WC |
$49.62
|
| Rate for Payer: Global Benefits Group Commercial |
$35.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Multiplan Commercial |
$43.78
|
| Rate for Payer: Networks By Design Commercial |
$29.19
|
| Rate for Payer: Prime Health Services Commercial |
$49.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.91
|
| Rate for Payer: United Healthcare All Other HMO |
$21.33
|
| Rate for Payer: United Healthcare HMO Rider |
$20.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.12
|
|
|
CHLORAMPHENICOL SODIUM SUCCINATE 1 GRAM INTRAVENOUS SOLUTION [25518]
|
Facility
|
OP
|
$58.38
|
|
|
Service Code
|
HCPCS J0720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$106.98 |
| Rate for Payer: Adventist Health Commercial |
$11.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.83
|
| Rate for Payer: Blue Shield of California Commercial |
$64.22
|
| Rate for Payer: Blue Shield of California EPN |
$58.38
|
| Rate for Payer: Cash Price |
$32.11
|
| Rate for Payer: Cash Price |
$32.11
|
| Rate for Payer: Central Health Plan Commercial |
$46.70
|
| Rate for Payer: Cigna of CA HMO |
$40.87
|
| Rate for Payer: Cigna of CA PPO |
$40.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.35
|
| Rate for Payer: EPIC Health Plan Senior |
$23.35
|
| Rate for Payer: Galaxy Health WC |
$49.62
|
| Rate for Payer: Global Benefits Group Commercial |
$35.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.35
|
| Rate for Payer: InnovAge PACE Commercial |
$29.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.87
|
| Rate for Payer: Multiplan Commercial |
$43.78
|
| Rate for Payer: Networks By Design Commercial |
$29.19
|
| Rate for Payer: Prime Health Services Commercial |
$49.62
|
| Rate for Payer: Riverside University Health System MISP |
$23.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.91
|
| Rate for Payer: United Healthcare All Other HMO |
$21.33
|
| Rate for Payer: United Healthcare HMO Rider |
$20.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.62
|
| Rate for Payer: Vantage Medical Group Senior |
$49.62
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0555-0033-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: InnovAge PACE Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0555-0033-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: InnovAge PACE Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Riverside University Health System MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0555-0033-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| 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 |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| 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 |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| 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 |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE [1622]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 0555-0033-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 51079-141-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 51079-141-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: InnovAge PACE Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 51079-141-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 51079-141-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: InnovAge PACE Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 0555-0159-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| 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
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE [1623]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 0555-0159-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.11
|
| 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: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.14
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
CHLORDIAZEPOXIDE 5 MG CAPSULE [1624]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 0555-0158-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: InnovAge PACE Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
