|
SOFT LENS ADJUNCTIVE SOLUTIONS EYE DROPS [117633]
|
Facility
IP
|
$0.49
|
|
|
Service Code
|
NDC 1011905220
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| 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 |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
SOFT TISSUE PROCEDURES WITH CC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 501
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
SOFT TISSUE PROCEDURES WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 500
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
SOFT TISSUE PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 502
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
SOLIFENACIN 5 MG TABLET [40392]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 67877-527-30
|
| Hospital Charge Code |
1710977
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| 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 |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
SOLIFENACIN 5 MG TABLET [40392]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 67877-527-30
|
| Hospital Charge Code |
1710977
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Riverside University Health MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
SOMATROPIN 1 MG/ML SOLUTION FOR INJECTION [408114182]
|
Facility
OP
|
$844.08
|
|
|
Service Code
|
CPT J2941
|
| Hospital Charge Code |
NDG40811418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$927.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$214.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$268.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$235.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$235.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.48
|
| Rate for Payer: BCBS Transplant Transplant |
$506.45
|
| Rate for Payer: Blue Shield of California Commercial |
$159.28
|
| Rate for Payer: Blue Shield of California EPN |
$144.80
|
| Rate for Payer: Caremore Medicare Advantage |
$214.47
|
| Rate for Payer: Cash Price |
$379.84
|
| Rate for Payer: Cash Price |
$379.84
|
| Rate for Payer: Central Health Plan Commercial |
$675.26
|
| Rate for Payer: Cigna of CA HMO |
$590.86
|
| Rate for Payer: Cigna of CA PPO |
$590.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$214.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$214.47
|
| Rate for Payer: Galaxy Health WC |
$717.47
|
| Rate for Payer: Global Benefits Group Commercial |
$506.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$633.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$351.73
|
| Rate for Payer: IEHP medi-cal |
$353.88
|
| Rate for Payer: IEHP Medicare Advantage |
$214.47
|
| Rate for Payer: Innovage PACE Commercial |
$321.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.39
|
| Rate for Payer: Multiplan Commercial |
$633.06
|
| Rate for Payer: Networks By Design Commercial |
$422.04
|
| Rate for Payer: Prime Health Services Commercial |
$717.47
|
| Rate for Payer: Prime Health Services Medicare |
$227.34
|
| Rate for Payer: Riverside University Health MISP |
$235.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.04
|
| Rate for Payer: United Healthcare All Other HMO |
$422.04
|
| Rate for Payer: United Healthcare HMO Rider |
$422.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$321.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.92
|
| Rate for Payer: Vantage Medical Group Senior |
$214.47
|
|
|
SOMATROPIN 1 MG/ML SOLUTION FOR INJECTION [408114182]
|
Facility
IP
|
$844.08
|
|
|
Service Code
|
CPT J2941
|
| Hospital Charge Code |
NDG40811418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.82 |
| 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 |
$633.06
|
| Rate for Payer: Blue Shield of California EPN |
$450.74
|
| Rate for Payer: Cash Price |
$379.84
|
| Rate for Payer: Cash Price |
$379.84
|
| Rate for Payer: Central Health Plan Commercial |
$675.26
|
| Rate for Payer: Cigna of CA HMO |
$590.86
|
| Rate for Payer: Cigna of CA PPO |
$590.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$337.63
|
| Rate for Payer: Galaxy Health WC |
$717.47
|
| Rate for Payer: Global Benefits Group Commercial |
$506.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$633.06
|
| Rate for Payer: Networks By Design Commercial |
$422.04
|
| Rate for Payer: Prime Health Services Commercial |
$717.47
|
|
|
SOMATROPIN 5 MG/1.5 ML (3.3 MG/ML) SUBCUTANEOUS PEN INJECTOR [117385]
|
Facility
OP
|
$614.28
|
|
|
Service Code
|
CPT J2941
|
| Hospital Charge Code |
NDG117385
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$927.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$214.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$268.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$235.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$235.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.48
|
| Rate for Payer: BCBS Transplant Transplant |
$368.57
|
| Rate for Payer: Blue Shield of California Commercial |
$159.28
|
| Rate for Payer: Blue Shield of California EPN |
$144.80
|
| Rate for Payer: Caremore Medicare Advantage |
$214.47
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Central Health Plan Commercial |
$491.42
|
| Rate for Payer: Cigna of CA HMO |
$430.00
|
| Rate for Payer: Cigna of CA PPO |
$430.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$214.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$214.47
|
| Rate for Payer: Galaxy Health WC |
$522.14
|
| Rate for Payer: Global Benefits Group Commercial |
$368.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$552.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$460.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$351.73
|
| Rate for Payer: IEHP medi-cal |
$353.88
|
| Rate for Payer: IEHP Medicare Advantage |
$214.47
|
| Rate for Payer: Innovage PACE Commercial |
$321.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$409.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.39
|
| Rate for Payer: Multiplan Commercial |
$460.71
|
| Rate for Payer: Networks By Design Commercial |
$307.14
|
| Rate for Payer: Prime Health Services Commercial |
$522.14
|
| Rate for Payer: Prime Health Services Medicare |
$227.34
|
| Rate for Payer: Riverside University Health MISP |
$235.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$368.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.14
|
| Rate for Payer: United Healthcare All Other HMO |
$307.14
|
| Rate for Payer: United Healthcare HMO Rider |
$307.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$307.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$321.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.92
|
| Rate for Payer: Vantage Medical Group Senior |
$214.47
|
|
|
SOMATROPIN 5 MG/1.5 ML (3.3 MG/ML) SUBCUTANEOUS PEN INJECTOR [117385]
|
Facility
IP
|
$614.28
|
|
|
Service Code
|
CPT J2941
|
| Hospital Charge Code |
NDG117385
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.86 |
| 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 |
$460.71
|
| Rate for Payer: Blue Shield of California EPN |
$328.03
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Cash Price |
$276.43
|
| Rate for Payer: Central Health Plan Commercial |
$491.42
|
| Rate for Payer: Cigna of CA HMO |
$430.00
|
| Rate for Payer: Cigna of CA PPO |
$430.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$245.71
|
| Rate for Payer: Galaxy Health WC |
$522.14
|
| Rate for Payer: Global Benefits Group Commercial |
$368.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$552.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$409.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.86
|
| Rate for Payer: Multiplan Commercial |
$460.71
|
| Rate for Payer: Networks By Design Commercial |
$307.14
|
| Rate for Payer: Prime Health Services Commercial |
$522.14
|
|
|
SOMATROPIN 6 MG (18 UNIT) INJECTION CARTRIDGE [14721]
|
Facility
IP
|
$1,116.72
|
|
|
Service Code
|
CPT J2941
|
| Hospital Charge Code |
ERX14721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$223.34 |
| 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 |
$837.54
|
| Rate for Payer: Blue Shield of California EPN |
$596.33
|
| Rate for Payer: Cash Price |
$502.52
|
| Rate for Payer: Cash Price |
$502.52
|
| Rate for Payer: Central Health Plan Commercial |
$893.38
|
| Rate for Payer: Cigna of CA HMO |
$781.70
|
| Rate for Payer: Cigna of CA PPO |
$781.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$446.69
|
| Rate for Payer: Galaxy Health WC |
$949.21
|
| Rate for Payer: Global Benefits Group Commercial |
$670.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,005.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.34
|
| Rate for Payer: Multiplan Commercial |
$837.54
|
| Rate for Payer: Networks By Design Commercial |
$558.36
|
| Rate for Payer: Prime Health Services Commercial |
$949.21
|
|
|
SOMATROPIN 6 MG (18 UNIT) INJECTION CARTRIDGE [14721]
|
Facility
OP
|
$1,116.72
|
|
|
Service Code
|
CPT J2941
|
| Hospital Charge Code |
ERX14721
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$1,005.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$214.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$268.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$235.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$235.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.48
|
| Rate for Payer: BCBS Transplant Transplant |
$670.03
|
| Rate for Payer: Blue Shield of California Commercial |
$159.28
|
| Rate for Payer: Blue Shield of California EPN |
$144.80
|
| Rate for Payer: Caremore Medicare Advantage |
$214.47
|
| Rate for Payer: Cash Price |
$502.52
|
| Rate for Payer: Cash Price |
$502.52
|
| Rate for Payer: Central Health Plan Commercial |
$893.38
|
| Rate for Payer: Cigna of CA HMO |
$781.70
|
| Rate for Payer: Cigna of CA PPO |
$781.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$214.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$214.47
|
| Rate for Payer: Galaxy Health WC |
$949.21
|
| Rate for Payer: Global Benefits Group Commercial |
$670.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,005.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$837.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$351.73
|
| Rate for Payer: IEHP medi-cal |
$353.88
|
| Rate for Payer: IEHP Medicare Advantage |
$214.47
|
| Rate for Payer: Innovage PACE Commercial |
$321.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.39
|
| Rate for Payer: Multiplan Commercial |
$837.54
|
| Rate for Payer: Networks By Design Commercial |
$558.36
|
| Rate for Payer: Prime Health Services Commercial |
$949.21
|
| Rate for Payer: Prime Health Services Medicare |
$227.34
|
| Rate for Payer: Riverside University Health MISP |
$235.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.36
|
| Rate for Payer: United Healthcare All Other HMO |
$558.36
|
| Rate for Payer: United Healthcare HMO Rider |
$558.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$321.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.92
|
| Rate for Payer: Vantage Medical Group Senior |
$214.47
|
|
|
SOMATROPIN INJECTION 5 MG/2 ML FOR NICU SPEC DIL [40811418]
|
Facility
IP
|
$844.08
|
|
|
Service Code
|
CPT J2941
|
| Hospital Charge Code |
NDG40811418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.82 |
| 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 |
$633.06
|
| Rate for Payer: Blue Shield of California EPN |
$450.74
|
| Rate for Payer: Cash Price |
$379.84
|
| Rate for Payer: Cash Price |
$379.84
|
| Rate for Payer: Central Health Plan Commercial |
$675.26
|
| Rate for Payer: Cigna of CA HMO |
$590.86
|
| Rate for Payer: Cigna of CA PPO |
$590.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$337.63
|
| Rate for Payer: Galaxy Health WC |
$717.47
|
| Rate for Payer: Global Benefits Group Commercial |
$506.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$633.06
|
| Rate for Payer: Networks By Design Commercial |
$422.04
|
| Rate for Payer: Prime Health Services Commercial |
$717.47
|
|
|
SOMATROPIN INJECTION 5 MG/2 ML FOR NICU SPEC DIL [40811418]
|
Facility
OP
|
$844.08
|
|
|
Service Code
|
CPT J2941
|
| Hospital Charge Code |
NDG40811418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$927.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$214.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$268.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$235.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$235.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.48
|
| Rate for Payer: BCBS Transplant Transplant |
$506.45
|
| Rate for Payer: Blue Shield of California Commercial |
$159.28
|
| Rate for Payer: Blue Shield of California EPN |
$144.80
|
| Rate for Payer: Caremore Medicare Advantage |
$214.47
|
| Rate for Payer: Cash Price |
$379.84
|
| Rate for Payer: Cash Price |
$379.84
|
| Rate for Payer: Central Health Plan Commercial |
$675.26
|
| Rate for Payer: Cigna of CA HMO |
$590.86
|
| Rate for Payer: Cigna of CA PPO |
$590.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$214.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$214.47
|
| Rate for Payer: Galaxy Health WC |
$717.47
|
| Rate for Payer: Global Benefits Group Commercial |
$506.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$633.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$351.73
|
| Rate for Payer: IEHP medi-cal |
$353.88
|
| Rate for Payer: IEHP Medicare Advantage |
$214.47
|
| Rate for Payer: Innovage PACE Commercial |
$321.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.39
|
| Rate for Payer: Multiplan Commercial |
$633.06
|
| Rate for Payer: Networks By Design Commercial |
$422.04
|
| Rate for Payer: Prime Health Services Commercial |
$717.47
|
| Rate for Payer: Prime Health Services Medicare |
$227.34
|
| Rate for Payer: Riverside University Health MISP |
$235.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.04
|
| Rate for Payer: United Healthcare All Other HMO |
$422.04
|
| Rate for Payer: United Healthcare HMO Rider |
$422.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$321.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.92
|
| Rate for Payer: Vantage Medical Group Senior |
$214.47
|
|
|
SORAFENIB 200 MG TABLET [43675]
|
Facility
OP
|
$240.70
|
|
|
Service Code
|
NDC 50419-488-58
|
| Hospital Charge Code |
1712493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$216.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$204.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$132.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$132.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.21
|
| Rate for Payer: BCBS Transplant Transplant |
$144.42
|
| Rate for Payer: Blue Shield of California Commercial |
$151.40
|
| Rate for Payer: Blue Shield of California EPN |
$117.70
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Central Health Plan Commercial |
$192.56
|
| Rate for Payer: Cigna of CA HMO |
$168.49
|
| Rate for Payer: Cigna of CA PPO |
$168.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.28
|
| Rate for Payer: Galaxy Health WC |
$204.60
|
| Rate for Payer: Global Benefits Group Commercial |
$144.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$180.52
|
| Rate for Payer: IEHP medi-cal |
$84.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.14
|
| Rate for Payer: Multiplan Commercial |
$180.52
|
| Rate for Payer: Networks By Design Commercial |
$156.46
|
| Rate for Payer: Prime Health Services Commercial |
$204.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$144.42
|
| Rate for Payer: Riverside University Health MISP |
$96.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.35
|
| Rate for Payer: United Healthcare All Other HMO |
$120.35
|
| Rate for Payer: United Healthcare HMO Rider |
$120.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.60
|
| Rate for Payer: Vantage Medical Group Senior |
$204.60
|
|
|
SORAFENIB 200 MG TABLET [43675]
|
Facility
IP
|
$240.70
|
|
|
Service Code
|
NDC 50419-488-58
|
| Hospital Charge Code |
1712493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.14 |
| 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 |
$180.52
|
| Rate for Payer: Blue Shield of California EPN |
$128.53
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Central Health Plan Commercial |
$192.56
|
| Rate for Payer: Cigna of CA HMO |
$168.49
|
| Rate for Payer: Cigna of CA PPO |
$168.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.28
|
| Rate for Payer: Galaxy Health WC |
$204.60
|
| Rate for Payer: Global Benefits Group Commercial |
$144.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.14
|
| Rate for Payer: Multiplan Commercial |
$180.52
|
| Rate for Payer: Networks By Design Commercial |
$156.46
|
| Rate for Payer: Prime Health Services Commercial |
$204.60
|
|
|
SORBITOL 70 % SOLUTION [7413]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 4628750001
|
| Hospital Charge Code |
NDG7413A
|
|
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
|
|
|
SORBITOL 70 % SOLUTION [7413]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 0121-0659-16
|
| Hospital Charge Code |
NDG7413A
|
|
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 |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| 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 |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$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 |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
SORBITOL 70 % SOLUTION [7413]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 0121-0659-16
|
| Hospital Charge Code |
NDG7413A
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| 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 |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: IEHP medi-cal |
$0.00
|
| 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 |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Riverside University Health MISP |
$0.00
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
SORBITOL 70 % SOLUTION [7413]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 4628750001
|
| Hospital Charge Code |
NDG7413A
|
|
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
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
OP
|
$0.58
|
|
|
Service Code
|
NDC 0378-5123-01
|
| Hospital Charge Code |
1711560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 60505-0080-0
|
| Hospital Charge Code |
1711560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
IP
|
$1.53
|
|
|
Service Code
|
NDC 68084-654-11
|
| Hospital Charge Code |
1711560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| 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 |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.07
|
| Rate for Payer: Cigna of CA PPO |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.30
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
IP
|
$0.58
|
|
|
Service Code
|
NDC 0378-5123-01
|
| Hospital Charge Code |
1711560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| 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 |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
SOTALOL 80 MG TABLET [11421]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 60505-0080-0
|
| Hospital Charge Code |
1711560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| 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 |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
