|
CICLOPIROX 0.77 % TOPICAL CREAM [9598]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 45802-138-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: InnovAge PACE Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Riverside University Health System MISP |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
CICLOPIROX 8 % TOPICAL SOLUTION [27158]
|
Facility
|
OP
|
$3.10
|
|
|
Service Code
|
NDC 21922-053-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Central Health Plan Commercial |
$2.48
|
| Rate for Payer: Cigna of CA HMO |
$2.17
|
| Rate for Payer: Cigna of CA PPO |
$2.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.24
|
| Rate for Payer: EPIC Health Plan Senior |
$1.24
|
| Rate for Payer: Galaxy Health WC |
$2.63
|
| Rate for Payer: Global Benefits Group Commercial |
$1.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.79
|
| Rate for Payer: InnovAge PACE Commercial |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$2.33
|
| Rate for Payer: Networks By Design Commercial |
$2.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.63
|
| Rate for Payer: Riverside University Health System MISP |
$1.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.63
|
| Rate for Payer: Vantage Medical Group Senior |
$2.63
|
|
|
CICLOPIROX 8 % TOPICAL SOLUTION [27158]
|
Facility
|
IP
|
$3.10
|
|
|
Service Code
|
NDC 21922-053-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Central Health Plan Commercial |
$2.48
|
| Rate for Payer: Cigna of CA HMO |
$2.17
|
| Rate for Payer: Cigna of CA PPO |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.24
|
| Rate for Payer: EPIC Health Plan Senior |
$1.24
|
| Rate for Payer: Galaxy Health WC |
$2.63
|
| Rate for Payer: Global Benefits Group Commercial |
$1.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.33
|
| Rate for Payer: Networks By Design Commercial |
$2.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.63
|
|
|
CICLOPIROX 8 % TOPICAL SOLUTION [27158]
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 45802-141-67
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$3.49
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.71
|
| Rate for Payer: Global Benefits Group Commercial |
$2.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.27
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.71
|
|
|
CICLOPIROX 8 % TOPICAL SOLUTION [27158]
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 45802-141-67
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$3.49
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.71
|
| Rate for Payer: Global Benefits Group Commercial |
$2.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: InnovAge PACE Commercial |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$3.27
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.71
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.18
|
| Rate for Payer: United Healthcare All Other HMO |
$2.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Vantage Medical Group Senior |
$3.71
|
|
|
CIDOFOVIR 10 MG/ML TOPICAL [4082503]
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
NDC 9994-0825-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Adventist Health Commercial |
$4.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.38
|
| Rate for Payer: Blue Shield of California Commercial |
$14.96
|
| Rate for Payer: Blue Shield of California EPN |
$9.77
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.14
|
| Rate for Payer: Cigna of CA PPO |
$17.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.81
|
| Rate for Payer: Global Benefits Group Commercial |
$14.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.03
|
| Rate for Payer: InnovAge PACE Commercial |
$12.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$18.36
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.81
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.24
|
| Rate for Payer: United Healthcare All Other HMO |
$12.24
|
| Rate for Payer: United Healthcare HMO Rider |
$12.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.81
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
CIDOFOVIR 10 MG/ML TOPICAL [4082503]
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
NDC 9994-0825-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Adventist Health Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California Commercial |
$18.92
|
| Rate for Payer: Blue Shield of California EPN |
$12.34
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Central Health Plan Commercial |
$19.58
|
| Rate for Payer: Cigna of CA HMO |
$17.14
|
| Rate for Payer: Cigna of CA PPO |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.79
|
| Rate for Payer: EPIC Health Plan Senior |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$20.81
|
| Rate for Payer: Global Benefits Group Commercial |
$14.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$18.36
|
| Rate for Payer: Networks By Design Commercial |
$15.91
|
| Rate for Payer: Prime Health Services Commercial |
$20.81
|
|
|
CIDOFOVIR 15 MG/ML TOPICAL [4081161]
|
Facility
|
IP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California Commercial |
$28.24
|
| Rate for Payer: Blue Shield of California EPN |
$18.41
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Central Health Plan Commercial |
$29.22
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$27.40
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
|
|
CIDOFOVIR 15 MG/ML TOPICAL [4081161]
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.45
|
| Rate for Payer: Blue Shield of California Commercial |
$22.32
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Central Health Plan Commercial |
$29.22
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.88
|
| Rate for Payer: InnovAge PACE Commercial |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$27.40
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
| Rate for Payer: Riverside University Health System MISP |
$14.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.05
|
| Rate for Payer: Vantage Medical Group Senior |
$31.05
|
|
|
CIDOFOVIR 1 MG/ML TOPICAL [4081092]
|
Facility
|
IP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-92
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California Commercial |
$28.24
|
| Rate for Payer: Blue Shield of California EPN |
$18.41
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Central Health Plan Commercial |
$29.22
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$27.40
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
|
|
CIDOFOVIR 1 MG/ML TOPICAL [4081092]
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-92
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.45
|
| Rate for Payer: Blue Shield of California Commercial |
$22.32
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Central Health Plan Commercial |
$29.22
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.88
|
| Rate for Payer: InnovAge PACE Commercial |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$27.40
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
| Rate for Payer: Riverside University Health System MISP |
$14.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.05
|
| Rate for Payer: Vantage Medical Group Senior |
$31.05
|
|
|
CIDOFOVIR 3 MG/ML TOPICAL [4081091]
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.45
|
| Rate for Payer: Blue Shield of California Commercial |
$22.32
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Central Health Plan Commercial |
$29.22
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.88
|
| Rate for Payer: InnovAge PACE Commercial |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$27.40
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
| Rate for Payer: Riverside University Health System MISP |
$14.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.05
|
| Rate for Payer: Vantage Medical Group Senior |
$31.05
|
|
|
CIDOFOVIR 3 MG/ML TOPICAL [4081091]
|
Facility
|
IP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California Commercial |
$28.24
|
| Rate for Payer: Blue Shield of California EPN |
$18.41
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Central Health Plan Commercial |
$29.22
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$27.40
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
|
|
CIDOFOVIR 5 MG/ML TOPICAL [4081159]
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-59
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.45
|
| Rate for Payer: Blue Shield of California Commercial |
$22.32
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Central Health Plan Commercial |
$29.22
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.88
|
| Rate for Payer: InnovAge PACE Commercial |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$27.40
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
| Rate for Payer: Riverside University Health System MISP |
$14.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$18.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.05
|
| Rate for Payer: Vantage Medical Group Senior |
$31.05
|
|
|
CIDOFOVIR 5 MG/ML TOPICAL [4081159]
|
Facility
|
IP
|
$36.53
|
|
|
Service Code
|
NDC 99994-811-59
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Adventist Health Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California Commercial |
$28.24
|
| Rate for Payer: Blue Shield of California EPN |
$18.41
|
| Rate for Payer: Cash Price |
$20.09
|
| Rate for Payer: Central Health Plan Commercial |
$29.22
|
| Rate for Payer: Cigna of CA HMO |
$25.57
|
| Rate for Payer: Cigna of CA PPO |
$25.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$31.05
|
| Rate for Payer: Global Benefits Group Commercial |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$27.40
|
| Rate for Payer: Networks By Design Commercial |
$23.74
|
| Rate for Payer: Prime Health Services Commercial |
$31.05
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [17378]
|
Facility
|
IP
|
$237.29
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$213.56 |
| Rate for Payer: Adventist Health Commercial |
$47.46
|
| Rate for Payer: Adventist Health Commercial |
$35.52
|
| Rate for Payer: Blue Shield of California Commercial |
$183.43
|
| Rate for Payer: Blue Shield of California Commercial |
$137.28
|
| Rate for Payer: Blue Shield of California EPN |
$89.51
|
| Rate for Payer: Blue Shield of California EPN |
$119.59
|
| Rate for Payer: Cash Price |
$130.51
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Central Health Plan Commercial |
$189.83
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: Cigna of CA HMO |
$124.32
|
| Rate for Payer: Cigna of CA HMO |
$166.10
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Cigna of CA PPO |
$166.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.92
|
| Rate for Payer: EPIC Health Plan Senior |
$71.04
|
| Rate for Payer: EPIC Health Plan Senior |
$94.92
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Galaxy Health WC |
$201.70
|
| Rate for Payer: Global Benefits Group Commercial |
$142.37
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Multiplan Commercial |
$177.97
|
| Rate for Payer: Networks By Design Commercial |
$88.80
|
| Rate for Payer: Networks By Design Commercial |
$118.64
|
| Rate for Payer: Prime Health Services Commercial |
$201.70
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.05
|
| Rate for Payer: United Healthcare All Other HMO |
$86.68
|
| Rate for Payer: United Healthcare All Other HMO |
$64.88
|
| Rate for Payer: United Healthcare HMO Rider |
$63.47
|
| Rate for Payer: United Healthcare HMO Rider |
$84.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.71
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [17378]
|
Facility
|
OP
|
$237.29
|
|
|
Service Code
|
HCPCS J0740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$1,900.72 |
| Rate for Payer: Adventist Health Commercial |
$47.46
|
| Rate for Payer: Adventist Health Commercial |
$35.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$529.38
|
| Rate for Payer: Adventist Health Medi-Cal |
$529.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$661.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$661.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$582.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$582.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$582.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$582.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,900.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,900.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$583.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$583.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,140.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,140.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,037.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,037.23
|
| Rate for Payer: Cash Price |
$130.51
|
| Rate for Payer: Cash Price |
$130.51
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Cash Price |
$97.68
|
| Rate for Payer: Central Health Plan Commercial |
$189.83
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: Cigna of CA HMO |
$124.32
|
| Rate for Payer: Cigna of CA HMO |
$166.10
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Cigna of CA PPO |
$166.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$661.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$661.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$582.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$582.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$582.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$582.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.66
|
| Rate for Payer: EPIC Health Plan Senior |
$529.38
|
| Rate for Payer: EPIC Health Plan Senior |
$529.38
|
| Rate for Payer: Galaxy Health WC |
$201.70
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$142.37
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$868.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$868.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$529.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$529.38
|
| Rate for Payer: InnovAge PACE Commercial |
$794.06
|
| Rate for Payer: InnovAge PACE Commercial |
$794.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$709.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$709.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$709.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$709.36
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Multiplan Commercial |
$177.97
|
| Rate for Payer: Networks By Design Commercial |
$118.64
|
| Rate for Payer: Networks By Design Commercial |
$88.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$529.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$529.38
|
| Rate for Payer: Prime Health Services Commercial |
$201.70
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: Prime Health Services Medicare |
$561.14
|
| Rate for Payer: Prime Health Services Medicare |
$561.14
|
| Rate for Payer: Riverside University Health System MISP |
$582.31
|
| Rate for Payer: Riverside University Health System MISP |
$582.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.05
|
| Rate for Payer: United Healthcare All Other HMO |
$64.88
|
| Rate for Payer: United Healthcare All Other HMO |
$86.68
|
| Rate for Payer: United Healthcare HMO Rider |
$63.47
|
| Rate for Payer: United Healthcare HMO Rider |
$84.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$529.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$529.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$661.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$661.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$582.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$582.31
|
| Rate for Payer: Vantage Medical Group Senior |
$582.31
|
| Rate for Payer: Vantage Medical Group Senior |
$582.31
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 0093-2064-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: InnovAge PACE Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
CILOSTAZOL 100 MG TABLET [24474]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 0093-2064-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
CILOSTAZOL 50 MG TABLET [24473]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 0093-2065-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: InnovAge PACE Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Riverside University Health System MISP |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
CILOSTAZOL 50 MG TABLET [24473]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 0093-2065-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 69097-410-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 16729-440-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 69097-410-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: InnovAge PACE Commercial |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CINACALCET 15 MG PARTIAL TABLET [40820825]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 16729-440-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: InnovAge PACE Commercial |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
