|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
OP
|
$46.08
|
|
|
Service Code
|
NDC 47335-236-83
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.22
|
| Rate for Payer: BCBS Transplant Transplant |
$27.65
|
| Rate for Payer: Blue Shield of California Commercial |
$28.98
|
| Rate for Payer: Blue Shield of California EPN |
$22.53
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Central Health Plan Commercial |
$36.86
|
| Rate for Payer: Cigna of CA HMO |
$32.26
|
| Rate for Payer: Cigna of CA PPO |
$32.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.43
|
| Rate for Payer: Galaxy Health WC |
$39.17
|
| Rate for Payer: Global Benefits Group Commercial |
$27.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.56
|
| Rate for Payer: IEHP medi-cal |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$34.56
|
| Rate for Payer: Networks By Design Commercial |
$29.95
|
| Rate for Payer: Prime Health Services Commercial |
$39.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.65
|
| Rate for Payer: Riverside University Health MISP |
$18.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.04
|
| Rate for Payer: United Healthcare All Other HMO |
$23.04
|
| Rate for Payer: United Healthcare HMO Rider |
$23.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.17
|
| Rate for Payer: Vantage Medical Group Senior |
$39.17
|
|
|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
OP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0801-1
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$90.08 |
| Max. Negotiated Rate |
$405.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$273.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$247.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.08
|
| Rate for Payer: BCBS Transplant Transplant |
$270.23
|
| Rate for Payer: Blue Shield of California Commercial |
$283.29
|
| Rate for Payer: Blue Shield of California EPN |
$220.24
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Central Health Plan Commercial |
$360.30
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$337.78
|
| Rate for Payer: IEHP medi-cal |
$157.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.08
|
| Rate for Payer: Multiplan Commercial |
$337.78
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$270.23
|
| Rate for Payer: Riverside University Health MISP |
$180.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.19
|
| Rate for Payer: United Healthcare All Other HMO |
$225.19
|
| Rate for Payer: United Healthcare HMO Rider |
$225.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.82
|
| Rate for Payer: Vantage Medical Group Senior |
$382.82
|
|
|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
IP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0801-5
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$90.08 |
| Max. Negotiated Rate |
$405.34 |
| Rate for Payer: Blue Shield of California Commercial |
$337.78
|
| Rate for Payer: Blue Shield of California EPN |
$240.50
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Central Health Plan Commercial |
$360.30
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.08
|
| Rate for Payer: Multiplan Commercial |
$337.78
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
|
|
AMBRISENTAN 5 MG TABLET [82307]
|
Facility
OP
|
$450.38
|
|
|
Service Code
|
NDC 61958-0801-5
|
| Hospital Charge Code |
ERX82307
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$90.08 |
| Max. Negotiated Rate |
$405.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$273.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$382.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$247.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.08
|
| Rate for Payer: BCBS Transplant Transplant |
$270.23
|
| Rate for Payer: Blue Shield of California Commercial |
$283.29
|
| Rate for Payer: Blue Shield of California EPN |
$220.24
|
| Rate for Payer: Cash Price |
$202.67
|
| Rate for Payer: Central Health Plan Commercial |
$360.30
|
| Rate for Payer: Cigna of CA HMO |
$315.27
|
| Rate for Payer: Cigna of CA PPO |
$315.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.15
|
| Rate for Payer: Galaxy Health WC |
$382.82
|
| Rate for Payer: Global Benefits Group Commercial |
$270.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$337.78
|
| Rate for Payer: IEHP medi-cal |
$157.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.08
|
| Rate for Payer: Multiplan Commercial |
$337.78
|
| Rate for Payer: Networks By Design Commercial |
$292.75
|
| Rate for Payer: Prime Health Services Commercial |
$382.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$270.23
|
| Rate for Payer: Riverside University Health MISP |
$180.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.19
|
| Rate for Payer: United Healthcare All Other HMO |
$225.19
|
| Rate for Payer: United Healthcare HMO Rider |
$225.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.82
|
| Rate for Payer: Vantage Medical Group Senior |
$382.82
|
|
|
AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [121296]
|
Facility
IP
|
$4.65
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
1752069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Blue Shield of California Commercial |
$3.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California Commercial |
$5.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.75
|
| Rate for Payer: Central Health Plan Commercial |
$5.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.59
|
| Rate for Payer: Central Health Plan Commercial |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$3.72
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$4.89
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$4.89
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$1.86
|
| Rate for Payer: Galaxy Health WC |
$5.94
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.19
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$5.24
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$3.50
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$5.94
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$3.95
|
|
|
AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION [121296]
|
Facility
OP
|
$2.19
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
1752069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: BCBS Transplant Transplant |
$4.19
|
| Rate for Payer: BCBS Transplant Transplant |
$2.88
|
| Rate for Payer: BCBS Transplant Transplant |
$4.41
|
| Rate for Payer: BCBS Transplant Transplant |
$2.79
|
| Rate for Payer: BCBS Transplant Transplant |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Central Health Plan Commercial |
$3.72
|
| Rate for Payer: Central Health Plan Commercial |
$5.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.75
|
| Rate for Payer: Central Health Plan Commercial |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA HMO |
$4.89
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$4.89
|
| Rate for Payer: Cigna of CA PPO |
$1.53
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Galaxy Health WC |
$5.94
|
| Rate for Payer: Galaxy Health WC |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$1.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.19
|
| Rate for Payer: Global Benefits Group Commercial |
$1.31
|
| Rate for Payer: Global Benefits Group Commercial |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.49
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Networks By Design Commercial |
$3.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$5.94
|
| Rate for Payer: Riverside University Health MISP |
$1.86
|
| Rate for Payer: Riverside University Health MISP |
$2.80
|
| Rate for Payer: Riverside University Health MISP |
$2.94
|
| Rate for Payer: Riverside University Health MISP |
$1.92
|
| Rate for Payer: Riverside University Health MISP |
$0.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO |
$3.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare HMO Rider |
$2.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.86
|
| Rate for Payer: Vantage Medical Group Senior |
$6.25
|
|
|
AMIKACIN 500 MG/2 ML INJECTION SOLUTION [121291]
|
Facility
IP
|
$7.35
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
1720006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Blue Shield of California Commercial |
$5.51
|
| Rate for Payer: Blue Shield of California Commercial |
$3.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Blue Shield of California EPN |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Central Health Plan Commercial |
$5.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$3.72
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$5.51
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
|
|
AMIKACIN 500 MG/2 ML INJECTION SOLUTION [121291]
|
Facility
OP
|
$4.65
|
|
|
Service Code
|
CPT J0278
|
| Hospital Charge Code |
1720006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: BCBS Transplant Transplant |
$2.79
|
| Rate for Payer: BCBS Transplant Transplant |
$2.88
|
| Rate for Payer: BCBS Transplant Transplant |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Central Health Plan Commercial |
$5.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.72
|
| Rate for Payer: Central Health Plan Commercial |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$5.14
|
| Rate for Payer: Cigna of CA PPO |
$3.26
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$6.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4.41
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.51
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$3.49
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$3.95
|
| Rate for Payer: Riverside University Health MISP |
$2.94
|
| Rate for Payer: Riverside University Health MISP |
$1.92
|
| Rate for Payer: Riverside University Health MISP |
$1.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
| Rate for Payer: Vantage Medical Group Senior |
$6.25
|
|
|
AMILORIDE 5 MG TABLET [391]
|
Facility
OP
|
$0.27
|
|
|
Service Code
|
NDC 0574-0292-01
|
| Hospital Charge Code |
1710531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Riverside University Health MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
AMILORIDE 5 MG TABLET [391]
|
Facility
IP
|
$0.27
|
|
|
Service Code
|
NDC 0574-0292-01
|
| Hospital Charge Code |
1710531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
AMINO ACID INFUSION 7 % INTRAVENOUS SOLUTION [4089055]
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
NDC 9994-0890-55
|
| Hospital Charge Code |
NDC4089055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Blue Shield of California Commercial |
$236.25
|
| Rate for Payer: Blue Shield of California EPN |
$168.21
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
AMINO ACID INFUSION 7 % INTRAVENOUS SOLUTION [4089055]
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
NDC 9994-0890-55
|
| Hospital Charge Code |
NDC4089055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$191.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$152.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.10
|
| Rate for Payer: BCBS Transplant Transplant |
$189.00
|
| Rate for Payer: Blue Shield of California Commercial |
$198.14
|
| Rate for Payer: Blue Shield of California EPN |
$154.04
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$236.25
|
| Rate for Payer: IEHP medi-cal |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Riverside University Health MISP |
$126.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO |
$157.50
|
| Rate for Payer: United Healthcare HMO Rider |
$157.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION [9062]
|
Facility
IP
|
$14.18
|
|
|
Service Code
|
NDC 49411-052-08
|
| Hospital Charge Code |
NDG9062
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Blue Shield of California Commercial |
$10.64
|
| Rate for Payer: Blue Shield of California EPN |
$7.57
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Central Health Plan Commercial |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$9.93
|
| Rate for Payer: Cigna of CA PPO |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.05
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION [9062]
|
Facility
OP
|
$14.18
|
|
|
Service Code
|
NDC 49411-052-08
|
| Hospital Charge Code |
NDG9062
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.38
|
| Rate for Payer: BCBS Transplant Transplant |
$8.51
|
| Rate for Payer: Blue Shield of California Commercial |
$8.92
|
| Rate for Payer: Blue Shield of California EPN |
$6.93
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Central Health Plan Commercial |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$9.93
|
| Rate for Payer: Cigna of CA PPO |
$9.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.64
|
| Rate for Payer: IEHP medi-cal |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: Riverside University Health MISP |
$5.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$7.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
CPT S0017
|
| Hospital Charge Code |
1720161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
CPT S0017
|
| Hospital Charge Code |
1720161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$49.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$10.13
|
| Rate for Payer: Blue Shield of California EPN |
$9.21
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| 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: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
| Rate for Payer: IEHP medi-cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| 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 |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
NDC 72205-049-30
|
| Hospital Charge Code |
1710315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.68
|
| Rate for Payer: BCBS Transplant Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Blue Shield of California EPN |
$6.36
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$9.10
|
| Rate for Payer: Cigna of CA PPO |
$9.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.75
|
| Rate for Payer: IEHP medi-cal |
$4.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: Riverside University Health MISP |
$5.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11.05
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
IP
|
$7.16
|
|
|
Service Code
|
NDC 69680-115-30
|
| Hospital Charge Code |
1710315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Blue Shield of California Commercial |
$5.37
|
| Rate for Payer: Blue Shield of California EPN |
$3.82
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Central Health Plan Commercial |
$5.73
|
| Rate for Payer: Cigna of CA HMO |
$5.01
|
| Rate for Payer: Cigna of CA PPO |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.37
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
OP
|
$7.16
|
|
|
Service Code
|
NDC 69680-115-30
|
| Hospital Charge Code |
1710315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.23
|
| Rate for Payer: BCBS Transplant Transplant |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Central Health Plan Commercial |
$5.73
|
| Rate for Payer: Cigna of CA HMO |
$5.01
|
| Rate for Payer: Cigna of CA PPO |
$5.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.37
|
| Rate for Payer: IEHP medi-cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.37
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.30
|
| Rate for Payer: Riverside University Health MISP |
$2.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Vantage Medical Group Senior |
$6.09
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
NDC 72205-049-30
|
| Hospital Charge Code |
1710315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Blue Shield of California Commercial |
$9.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.94
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$9.10
|
| Rate for Payer: Cigna of CA PPO |
$9.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
NDC 70377-102-11
|
| Hospital Charge Code |
1710315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.27
|
| Rate for Payer: BCBS Transplant Transplant |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.81
|
| Rate for Payer: Blue Shield of California EPN |
$6.85
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$9.80
|
| Rate for Payer: Cigna of CA PPO |
$9.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.50
|
| Rate for Payer: IEHP medi-cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: Riverside University Health MISP |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
NDC 70377-102-11
|
| Hospital Charge Code |
1710315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Blue Shield of California Commercial |
$10.50
|
| Rate for Payer: Blue Shield of California EPN |
$7.48
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$9.80
|
| Rate for Payer: Cigna of CA PPO |
$9.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION [407]
|
Facility
OP
|
$1.72
|
|
|
Service Code
|
CPT J0280
|
| Hospital Charge Code |
1720024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$31.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$10.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.29
|
| Rate for Payer: IEHP medi-cal |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Riverside University Health MISP |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION [407]
|
Facility
IP
|
$1.72
|
|
|
Service Code
|
CPT J0280
|
| Hospital Charge Code |
1720024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION CDL ONLY [4084072]
|
Facility
OP
|
$1.72
|
|
|
Service Code
|
CPT J0280
|
| Hospital Charge Code |
1720024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$31.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$10.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.29
|
| Rate for Payer: IEHP medi-cal |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Riverside University Health MISP |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
