|
COENZYME Q10 100 MG CAPSULE [24678]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 8770140816
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
COENZYME Q10 100 MG CAPSULE [24678]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 8770140816
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: InnovAge PACE Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
COENZYME Q10 100 MG CAPSULE [24678]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 7985407974
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| 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 |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| 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 |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
COENZYME Q10 100 MG CAPSULE [24678]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 4098527413
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: InnovAge PACE Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
COENZYME Q10 200 MG CAPSULE [41804]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 8770140817
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| 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: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.19
|
| 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: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.24
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
COENZYME Q10 200 MG CAPSULE [41804]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 8770140817
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.19
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.21
|
| 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
|
|
|
COENZYME Q10 30 MG CAPSULE [13257]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 4098521341
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
COENZYME Q10 30 MG CAPSULE [13257]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 4098521341
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: InnovAge PACE Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
COENZYME Q10 (LIPOSOMAL UBIQUINOL) 100 MG/5 ML ORAL SUSPENSION [119471]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 33739-318-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: InnovAge PACE Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
COENZYME Q10 (LIPOSOMAL UBIQUINOL) 100 MG/5 ML ORAL SUSPENSION [119471]
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 33739-318-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
COIL TERUMO AZUR CX 018 2X4
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
COIL TERUMO AZUR CX 018 2X4
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
COIL TERUMO AZUR CX 018 3X4
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
COIL TERUMO AZUR CX 018 3X4
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
COIL TERUMO AZUR CX 018 3X8
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
COIL TERUMO AZUR CX 018 3X8
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
COLCHICINE 0.3 MG 1/2 TAB [4081490]
|
Facility
|
IP
|
$6.27
|
|
|
Service Code
|
NDC 9994-0814-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.85
|
| Rate for Payer: Blue Shield of California EPN |
$3.16
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.39
|
| Rate for Payer: Cigna of CA PPO |
$4.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.33
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.33
|
|
|
COLCHICINE 0.3 MG 1/2 TAB [4081490]
|
Facility
|
OP
|
$6.27
|
|
|
Service Code
|
NDC 9994-0814-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.83
|
| Rate for Payer: Blue Shield of California EPN |
$2.50
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: Central Health Plan Commercial |
$5.02
|
| Rate for Payer: Cigna of CA HMO |
$4.39
|
| Rate for Payer: Cigna of CA PPO |
$4.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.33
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.64
|
| Rate for Payer: InnovAge PACE Commercial |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.39
|
| Rate for Payer: Multiplan Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.33
|
| Rate for Payer: Riverside University Health System MISP |
$2.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.13
|
| Rate for Payer: United Healthcare All Other HMO |
$3.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.33
|
| Rate for Payer: Vantage Medical Group Senior |
$5.33
|
|
|
COLCHICINE 0.6 MG CAPSULE [207785]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
NDC 0143-3018-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$5.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
|
|
COLCHICINE 0.6 MG CAPSULE [207785]
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
NDC 60687-358-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Networks By Design Commercial |
$5.30
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
|
|
COLCHICINE 0.6 MG CAPSULE [207785]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
NDC 0143-3018-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Riverside University Health System MISP |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
COLCHICINE 0.6 MG CAPSULE [207785]
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
NDC 60687-358-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Networks By Design Commercial |
$5.30
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
|
|
COLCHICINE 0.6 MG CAPSULE [207785]
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
NDC 60687-358-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4.99
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: InnovAge PACE Commercial |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Networks By Design Commercial |
$5.30
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Riverside University Health System MISP |
$3.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$4.08
|
| Rate for Payer: United Healthcare HMO Rider |
$4.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
|
|
COLCHICINE 0.6 MG CAPSULE [207785]
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
NDC 60687-358-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4.99
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Central Health Plan Commercial |
$6.53
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.34
|
| Rate for Payer: InnovAge PACE Commercial |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Networks By Design Commercial |
$5.30
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Riverside University Health System MISP |
$3.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$4.08
|
| Rate for Payer: United Healthcare HMO Rider |
$4.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
|
|
COLCHICINE 0.6 MG TABLET [1821]
|
Facility
|
IP
|
$11.15
|
|
|
Service Code
|
NDC 60687-727-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Adventist Health Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California Commercial |
$8.62
|
| Rate for Payer: Blue Shield of California EPN |
$5.62
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Central Health Plan Commercial |
$8.92
|
| Rate for Payer: Cigna of CA HMO |
$7.80
|
| Rate for Payer: Cigna of CA PPO |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Senior |
$4.46
|
| Rate for Payer: Galaxy Health WC |
$9.48
|
| Rate for Payer: Global Benefits Group Commercial |
$6.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$8.36
|
| Rate for Payer: Networks By Design Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$9.48
|
|
