|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.01
|
| Rate for Payer: Blue Distinction Transplant |
$2.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Central Health Plan Commercial |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$2.39
|
| Rate for Payer: Cigna of CA PPO |
$2.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.90
|
| Rate for Payer: Dignity Health Media |
$2.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.22
|
| Rate for Payer: Prime Health Services Commercial |
$2.90
|
| Rate for Payer: Riverside University Health System MISP |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
NDC 0173-0682-24
|
| Hospital Charge Code |
1744126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Central Health Plan Commercial |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$2.39
|
| Rate for Payer: Cigna of CA PPO |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.22
|
| Rate for Payer: Prime Health Services Commercial |
$2.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]
|
Facility
|
IP
|
$5.08
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
1744112
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Blue Shield of California Commercial |
$3.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: Cigna of CA HMO |
$3.56
|
| Rate for Payer: Cigna of CA PPO |
$3.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$13,820.58
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$8,728.79 |
| Max. Negotiated Rate |
$13,820.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,728.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,401.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,820.58
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$5,928.68
|
|
|
Service Code
|
APR-DRG 7751
|
| Min. Negotiated Rate |
$3,744.43 |
| Max. Negotiated Rate |
$5,928.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,744.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,462.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,928.68
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$30,613.46
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$19,334.82 |
| Max. Negotiated Rate |
$30,613.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,334.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,040.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,613.46
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$8,120.68
|
|
|
Service Code
|
APR-DRG 7752
|
| Min. Negotiated Rate |
$5,128.85 |
| Max. Negotiated Rate |
$8,120.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,128.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,111.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,120.68
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$8,876.17
|
|
|
Service Code
|
APR-DRG 7722
|
| Min. Negotiated Rate |
$5,606.00 |
| Max. Negotiated Rate |
$8,876.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,606.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,680.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,876.17
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$7,219.75
|
|
|
Service Code
|
APR-DRG 7721
|
| Min. Negotiated Rate |
$4,559.84 |
| Max. Negotiated Rate |
$7,219.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,559.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,433.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,219.75
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$10,869.54
|
|
|
Service Code
|
APR-DRG 7723
|
| Min. Negotiated Rate |
$6,864.97 |
| Max. Negotiated Rate |
$10,869.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,864.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,869.54
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$28,698.13
|
|
|
Service Code
|
APR-DRG 7724
|
| Min. Negotiated Rate |
$18,125.14 |
| Max. Negotiated Rate |
$28,698.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,125.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,599.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,698.13
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$8,079.88
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$5,103.08 |
| Max. Negotiated Rate |
$8,079.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,103.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,081.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,079.88
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$15,874.23
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$10,025.83 |
| Max. Negotiated Rate |
$15,874.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,025.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,947.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,874.23
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$33,387.16
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$21,086.63 |
| Max. Negotiated Rate |
$33,387.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,086.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,128.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,387.16
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
IP
|
$10,426.17
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$6,584.95 |
| Max. Negotiated Rate |
$10,426.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,584.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,847.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,426.17
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
|
OP
|
$87.45
|
|
|
Service Code
|
NDC 50242-130-01
|
| Hospital Charge Code |
ERX212384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$78.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.67
|
| Rate for Payer: Blue Distinction Transplant |
$52.47
|
| Rate for Payer: Blue Shield of California Commercial |
$55.01
|
| Rate for Payer: Blue Shield of California EPN |
$42.76
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Central Health Plan Commercial |
$69.96
|
| Rate for Payer: Cigna of CA HMO |
$61.22
|
| Rate for Payer: Cigna of CA PPO |
$61.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.33
|
| Rate for Payer: Dignity Health Media |
$74.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.98
|
| Rate for Payer: Galaxy Health WC |
$74.33
|
| Rate for Payer: Global Benefits Group Commercial |
$52.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$65.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$65.59
|
| Rate for Payer: Networks By Design Commercial |
$56.84
|
| Rate for Payer: Prime Health Services Commercial |
$74.33
|
| Rate for Payer: Riverside University Health System MISP |
$34.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.72
|
| Rate for Payer: United Healthcare All Other HMO |
$43.72
|
| Rate for Payer: United Healthcare HMO Rider |
$43.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.33
|
| Rate for Payer: Vantage Medical Group Senior |
$74.33
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
|
IP
|
$87.45
|
|
|
Service Code
|
NDC 50242-130-01
|
| Hospital Charge Code |
ERX212384
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$78.70 |
| Rate for Payer: Blue Shield of California Commercial |
$65.59
|
| Rate for Payer: Blue Shield of California EPN |
$46.70
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Central Health Plan Commercial |
$69.96
|
| Rate for Payer: Cigna of CA HMO |
$61.22
|
| Rate for Payer: Cigna of CA PPO |
$61.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.98
|
| Rate for Payer: Galaxy Health WC |
$74.33
|
| Rate for Payer: Global Benefits Group Commercial |
$52.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$65.59
|
| Rate for Payer: Networks By Design Commercial |
$56.84
|
| Rate for Payer: Prime Health Services Commercial |
$74.33
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
|
IP
|
$28,798.18
|
|
|
Service Code
|
CPT J0202
|
| Hospital Charge Code |
NDG208005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,759.64 |
| Max. Negotiated Rate |
$25,918.36 |
| Rate for Payer: Blue Shield of California Commercial |
$21,598.64
|
| Rate for Payer: Blue Shield of California EPN |
$15,378.23
|
| Rate for Payer: Cash Price |
$12,959.18
|
| Rate for Payer: Central Health Plan Commercial |
$23,038.54
|
| Rate for Payer: Cigna of CA HMO |
$20,158.73
|
| Rate for Payer: Cigna of CA PPO |
$20,158.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,519.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,519.27
|
| Rate for Payer: Galaxy Health WC |
$24,478.45
|
| Rate for Payer: Global Benefits Group Commercial |
$17,278.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,918.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,208.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,972.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,759.64
|
| Rate for Payer: Multiplan Commercial |
$21,598.64
|
| Rate for Payer: Networks By Design Commercial |
$14,399.09
|
| Rate for Payer: Prime Health Services Commercial |
$24,478.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,874.19
|
| Rate for Payer: United Healthcare All Other HMO |
$10,620.77
|
| Rate for Payer: United Healthcare HMO Rider |
$10,390.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,503.40
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
|
OP
|
$28,798.18
|
|
|
Service Code
|
CPT J0202
|
| Hospital Charge Code |
NDG208005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,324.34 |
| Max. Negotiated Rate |
$25,918.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,324.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14,404.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,905.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,556.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,257.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,566.40
|
| Rate for Payer: Blue Distinction Transplant |
$17,278.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,709.81
|
| Rate for Payer: Blue Shield of California EPN |
$2,463.46
|
| Rate for Payer: Caremore Medicare Advantage |
$2,324.34
|
| Rate for Payer: Cash Price |
$12,959.18
|
| Rate for Payer: Cash Price |
$12,959.18
|
| Rate for Payer: Central Health Plan Commercial |
$23,038.54
|
| Rate for Payer: Cigna of CA HMO |
$20,158.73
|
| Rate for Payer: Cigna of CA PPO |
$20,158.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.52
|
| Rate for Payer: Dignity Health Media |
$2,324.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,324.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,324.34
|
| Rate for Payer: Galaxy Health WC |
$24,478.45
|
| Rate for Payer: Global Benefits Group Commercial |
$17,278.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,918.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21,598.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,835.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,208.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,424.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,759.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.62
|
| Rate for Payer: Multiplan Commercial |
$21,598.64
|
| Rate for Payer: Networks By Design Commercial |
$14,399.09
|
| Rate for Payer: Prime Health Services Commercial |
$24,478.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.80
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,278.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,278.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,399.09
|
| Rate for Payer: United Healthcare All Other HMO |
$14,399.09
|
| Rate for Payer: United Healthcare HMO Rider |
$14,399.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,399.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.78
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.34
|
|
|
ALENDRONATE 10 MG TABLET [15661]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 64980-340-03
|
| Hospital Charge Code |
1711759
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| 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 |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Distinction Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Media |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| 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 |
$0.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| 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 Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
ALENDRONATE 10 MG TABLET [15661]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 64980-340-03
|
| Hospital Charge Code |
1711759
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| 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 |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
NDC 0054-0282-59
|
| Hospital Charge Code |
1715162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Blue Distinction Transplant |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Media |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]
|
Facility
|
IP
|
$1.10
|
|
|
Service Code
|
NDC 0054-0282-59
|
| Hospital Charge Code |
1715162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
NDC 69543-131-20
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.68
|
| Rate for Payer: Cigna of CA HMO |
$2.34
|
| Rate for Payer: Cigna of CA PPO |
$2.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.85
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 65862-329-04
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Central Health Plan Commercial |
$1.32
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.40
|
|
