|
Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family
|
Facility
OP
|
$7,609.02
|
|
|
Service Code
|
CPT 36245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family
|
Facility
OP
|
$7,609.02
|
|
|
Service Code
|
CPT 36215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family
|
Facility
OP
|
$7,609.02
|
|
|
Service Code
|
CPT 36246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family
|
Facility
OP
|
$7,609.02
|
|
|
Service Code
|
CPT 36216
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family
|
Facility
OP
|
$7,609.02
|
|
|
Service Code
|
CPT 36247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
SELEGILINE 5 MG CAPSULE [17280]
|
Facility
OP
|
$2.01
|
|
|
Service Code
|
NDC 60505-0055-1
|
| Hospital Charge Code |
1712623
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.19
|
| Rate for Payer: BCBS Transplant Transplant |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.51
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: Riverside University Health MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1.71
|
|
|
SELEGILINE 5 MG CAPSULE [17280]
|
Facility
IP
|
$2.01
|
|
|
Service Code
|
NDC 60505-0055-1
|
| Hospital Charge Code |
1712623
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Cigna of CA PPO |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$1.41
|
| Rate for Payer: Galaxy Health WC |
$1.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: Networks By Design Commercial |
$1.31
|
| Rate for Payer: Prime Health Services Commercial |
$1.71
|
|
|
SELENIUM 200 MCG TABLET [7139]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 7985401163
|
| Hospital Charge Code |
ERX7139
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| 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: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| 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: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
SELENIUM 200 MCG TABLET [7139]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 7985401163
|
| Hospital Charge Code |
ERX7139
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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: 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: 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
|
|
|
SELENIUM 50 MCG TABLET [7140]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 26899-721-74
|
| Hospital Charge Code |
1710887
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| 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: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
SELENIUM 50 MCG TABLET [7140]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 26899-721-74
|
| Hospital Charge Code |
1710887
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare 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 |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| 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 |
$0.04
|
| 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 |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| 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 Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION [225026]
|
Facility
OP
|
$41.16
|
|
|
Service Code
|
NDC 0517-6560-25
|
| Hospital Charge Code |
NDG225026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$37.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.32
|
| Rate for Payer: BCBS Transplant Transplant |
$24.70
|
| Rate for Payer: Blue Shield of California Commercial |
$25.89
|
| Rate for Payer: Blue Shield of California EPN |
$20.13
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Central Health Plan Commercial |
$32.93
|
| Rate for Payer: Cigna of CA HMO |
$26.34
|
| Rate for Payer: Cigna of CA PPO |
$30.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.87
|
| Rate for Payer: IEHP medi-cal |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.23
|
| Rate for Payer: Multiplan Commercial |
$30.87
|
| Rate for Payer: Networks By Design Commercial |
$26.75
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
| Rate for Payer: Riverside University Health MISP |
$16.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.58
|
| Rate for Payer: United Healthcare All Other HMO |
$20.58
|
| Rate for Payer: United Healthcare HMO Rider |
$20.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.99
|
| Rate for Payer: Vantage Medical Group Senior |
$34.99
|
|
|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION [225026]
|
Facility
IP
|
$41.16
|
|
|
Service Code
|
NDC 0517-6560-25
|
| Hospital Charge Code |
NDG225026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California EPN |
$21.98
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Central Health Plan Commercial |
$32.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$34.99
|
| Rate for Payer: Global Benefits Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.23
|
| Rate for Payer: Multiplan Commercial |
$30.87
|
| Rate for Payer: Networks By Design Commercial |
$26.75
|
| Rate for Payer: Prime Health Services Commercial |
$34.99
|
|
|
SELENIUM SULFIDE 1 % SHAMPOO [38961]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 0536-1995-53
|
| Hospital Charge Code |
1743730
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
SELENIUM SULFIDE 1 % SHAMPOO [38961]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 0536-1995-53
|
| Hospital Charge Code |
1743730
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
SELENIUM SULFIDE 2.25 % SHAMPOO [40158]
|
Facility
IP
|
$0.75
|
|
|
Service Code
|
NDC 42192-152-06
|
| Hospital Charge Code |
NDG40158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
|
|
SELENIUM SULFIDE 2.25 % SHAMPOO [40158]
|
Facility
OP
|
$0.75
|
|
|
Service Code
|
NDC 42192-152-06
|
| Hospital Charge Code |
NDG40158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: BCBS Transplant Transplant |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.56
|
| Rate for Payer: IEHP medi-cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.45
|
| Rate for Payer: Riverside University Health MISP |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
SELEXIPAG 200 MCG TABLET [212415]
|
Facility
IP
|
$271.97
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212415
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$203.98
|
| Rate for Payer: Blue Shield of California EPN |
$145.23
|
| Rate for Payer: Cash Price |
$122.39
|
| Rate for Payer: Cash Price |
$122.39
|
| Rate for Payer: Central Health Plan Commercial |
$217.58
|
| Rate for Payer: Cigna of CA HMO |
$190.38
|
| Rate for Payer: Cigna of CA PPO |
$190.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.79
|
| Rate for Payer: Galaxy Health WC |
$231.17
|
| Rate for Payer: Global Benefits Group Commercial |
$163.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.39
|
| Rate for Payer: Multiplan Commercial |
$203.98
|
| Rate for Payer: Networks By Design Commercial |
$176.78
|
| Rate for Payer: Prime Health Services Commercial |
$231.17
|
|
|
SELEXIPAG 200 MCG TABLET [212415]
|
Facility
OP
|
$271.97
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212415
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$244.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$165.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$231.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$149.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$149.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.68
|
| Rate for Payer: BCBS Transplant Transplant |
$163.18
|
| Rate for Payer: Blue Shield of California Commercial |
$171.07
|
| Rate for Payer: Blue Shield of California EPN |
$132.99
|
| Rate for Payer: Cash Price |
$122.39
|
| Rate for Payer: Central Health Plan Commercial |
$217.58
|
| Rate for Payer: Cigna of CA HMO |
$190.38
|
| Rate for Payer: Cigna of CA PPO |
$190.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.79
|
| Rate for Payer: Galaxy Health WC |
$231.17
|
| Rate for Payer: Global Benefits Group Commercial |
$163.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$203.98
|
| Rate for Payer: IEHP medi-cal |
$95.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.39
|
| Rate for Payer: Multiplan Commercial |
$203.98
|
| Rate for Payer: Networks By Design Commercial |
$176.78
|
| Rate for Payer: Prime Health Services Commercial |
$231.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$163.18
|
| Rate for Payer: Riverside University Health MISP |
$108.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.98
|
| Rate for Payer: United Healthcare All Other HMO |
$135.98
|
| Rate for Payer: United Healthcare HMO Rider |
$135.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.17
|
| Rate for Payer: Vantage Medical Group Senior |
$231.17
|
|
|
SELEXIPAG 400 MCG TABLET [212416]
|
Facility
OP
|
$422.95
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$380.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$256.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$359.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$232.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$232.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$204.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.88
|
| Rate for Payer: BCBS Transplant Transplant |
$253.77
|
| Rate for Payer: Blue Shield of California Commercial |
$266.04
|
| Rate for Payer: Blue Shield of California EPN |
$206.82
|
| Rate for Payer: Cash Price |
$190.33
|
| Rate for Payer: Central Health Plan Commercial |
$338.36
|
| Rate for Payer: Cigna of CA HMO |
$296.06
|
| Rate for Payer: Cigna of CA PPO |
$296.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.18
|
| Rate for Payer: Galaxy Health WC |
$359.51
|
| Rate for Payer: Global Benefits Group Commercial |
$253.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$317.21
|
| Rate for Payer: IEHP medi-cal |
$148.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.59
|
| Rate for Payer: Multiplan Commercial |
$317.21
|
| Rate for Payer: Networks By Design Commercial |
$274.92
|
| Rate for Payer: Prime Health Services Commercial |
$359.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$253.77
|
| Rate for Payer: Riverside University Health MISP |
$169.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.48
|
| Rate for Payer: United Healthcare All Other HMO |
$211.48
|
| Rate for Payer: United Healthcare HMO Rider |
$211.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.51
|
| Rate for Payer: Vantage Medical Group Senior |
$359.51
|
|
|
SELEXIPAG 400 MCG TABLET [212416]
|
Facility
IP
|
$422.95
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
ERX212416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$317.21
|
| Rate for Payer: Blue Shield of California EPN |
$225.86
|
| Rate for Payer: Cash Price |
$190.33
|
| Rate for Payer: Cash Price |
$190.33
|
| Rate for Payer: Central Health Plan Commercial |
$338.36
|
| Rate for Payer: Cigna of CA HMO |
$296.06
|
| Rate for Payer: Cigna of CA PPO |
$296.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.18
|
| Rate for Payer: Galaxy Health WC |
$359.51
|
| Rate for Payer: Global Benefits Group Commercial |
$253.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.59
|
| Rate for Payer: Multiplan Commercial |
$317.21
|
| Rate for Payer: Networks By Design Commercial |
$274.92
|
| Rate for Payer: Prime Health Services Commercial |
$359.51
|
|
|
SELPERCATINIB 40 MG CAPSULE [228076]
|
Facility
IP
|
$141.46
|
|
|
Service Code
|
NDC 0002-3977-60
|
| Hospital Charge Code |
ERX228076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.29 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$106.10
|
| Rate for Payer: Blue Shield of California EPN |
$75.54
|
| Rate for Payer: Cash Price |
$63.66
|
| Rate for Payer: Cash Price |
$63.66
|
| Rate for Payer: Central Health Plan Commercial |
$113.17
|
| Rate for Payer: Cigna of CA HMO |
$99.02
|
| Rate for Payer: Cigna of CA PPO |
$99.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.58
|
| Rate for Payer: Galaxy Health WC |
$120.24
|
| Rate for Payer: Global Benefits Group Commercial |
$84.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.29
|
| Rate for Payer: Multiplan Commercial |
$106.10
|
| Rate for Payer: Networks By Design Commercial |
$91.95
|
| Rate for Payer: Prime Health Services Commercial |
$120.24
|
|
|
SELPERCATINIB 40 MG CAPSULE [228076]
|
Facility
OP
|
$141.46
|
|
|
Service Code
|
NDC 0002-3977-60
|
| Hospital Charge Code |
ERX228076
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.29 |
| Max. Negotiated Rate |
$127.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.57
|
| Rate for Payer: BCBS Transplant Transplant |
$84.88
|
| Rate for Payer: Blue Shield of California Commercial |
$88.98
|
| Rate for Payer: Blue Shield of California EPN |
$69.17
|
| Rate for Payer: Cash Price |
$63.66
|
| Rate for Payer: Central Health Plan Commercial |
$113.17
|
| Rate for Payer: Cigna of CA HMO |
$99.02
|
| Rate for Payer: Cigna of CA PPO |
$99.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.58
|
| Rate for Payer: Galaxy Health WC |
$120.24
|
| Rate for Payer: Global Benefits Group Commercial |
$84.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$106.10
|
| Rate for Payer: IEHP medi-cal |
$49.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.29
|
| Rate for Payer: Multiplan Commercial |
$106.10
|
| Rate for Payer: Networks By Design Commercial |
$91.95
|
| Rate for Payer: Prime Health Services Commercial |
$120.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$84.88
|
| Rate for Payer: Riverside University Health MISP |
$56.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.73
|
| Rate for Payer: United Healthcare All Other HMO |
$70.73
|
| Rate for Payer: United Healthcare HMO Rider |
$70.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.24
|
| Rate for Payer: Vantage Medical Group Senior |
$120.24
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
IP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-26
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.44 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Multiplan Commercial |
$159.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$159.14
|
| Rate for Payer: Blue Shield of California EPN |
$113.30
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: Central Health Plan Commercial |
$169.74
|
| Rate for Payer: Cigna of CA HMO |
$148.53
|
| Rate for Payer: Cigna of CA PPO |
$148.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.87
|
| Rate for Payer: Galaxy Health WC |
$180.35
|
| Rate for Payer: Global Benefits Group Commercial |
$127.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.44
|
| Rate for Payer: Networks By Design Commercial |
$137.92
|
| Rate for Payer: Prime Health Services Commercial |
$180.35
|
|
|
SELPERCATINIB 80 MG CAPSULE [228077]
|
Facility
OP
|
$212.18
|
|
|
Service Code
|
NDC 0002-2980-60
|
| Hospital Charge Code |
ERX228077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.44 |
| Max. Negotiated Rate |
$190.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$180.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.36
|
| Rate for Payer: BCBS Transplant Transplant |
$127.31
|
| Rate for Payer: Blue Shield of California Commercial |
$133.46
|
| Rate for Payer: Blue Shield of California EPN |
$103.76
|
| Rate for Payer: Cash Price |
$95.48
|
| Rate for Payer: Central Health Plan Commercial |
$169.74
|
| Rate for Payer: Cigna of CA HMO |
$148.53
|
| Rate for Payer: Cigna of CA PPO |
$148.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.87
|
| Rate for Payer: Galaxy Health WC |
$180.35
|
| Rate for Payer: Global Benefits Group Commercial |
$127.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.14
|
| Rate for Payer: IEHP medi-cal |
$74.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.44
|
| Rate for Payer: Multiplan Commercial |
$159.14
|
| Rate for Payer: Networks By Design Commercial |
$137.92
|
| Rate for Payer: Prime Health Services Commercial |
$180.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.31
|
| Rate for Payer: Riverside University Health MISP |
$84.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.09
|
| Rate for Payer: United Healthcare All Other HMO |
$106.09
|
| Rate for Payer: United Healthcare HMO Rider |
$106.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.35
|
| Rate for Payer: Vantage Medical Group Senior |
$180.35
|
|
