|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
OP
|
$4.73
|
|
|
Service Code
|
NDC 98193-00005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Central Health Plan Commercial |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$3.31
|
| Rate for Payer: Cigna of CA PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$4.02
|
| Rate for Payer: Global Benefits Group Commercial |
$2.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.26
|
| Rate for Payer: InnovAge PACE Commercial |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
| Rate for Payer: Networks By Design Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.02
|
| Rate for Payer: Riverside University Health System MISP |
$1.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.37
|
| Rate for Payer: United Healthcare All Other HMO |
$2.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.02
|
| Rate for Payer: Vantage Medical Group Senior |
$4.02
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
OP
|
$35.74
|
|
|
Service Code
|
NDC 98193-000-17
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.99
|
| Rate for Payer: Blue Shield of California Commercial |
$21.84
|
| Rate for Payer: Blue Shield of California EPN |
$14.26
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Central Health Plan Commercial |
$28.59
|
| Rate for Payer: Cigna of CA HMO |
$25.02
|
| Rate for Payer: Cigna of CA PPO |
$25.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.38
|
| Rate for Payer: Global Benefits Group Commercial |
$21.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: InnovAge PACE Commercial |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.80
|
| Rate for Payer: Networks By Design Commercial |
$23.23
|
| Rate for Payer: Prime Health Services Commercial |
$30.38
|
| Rate for Payer: Riverside University Health System MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.87
|
| Rate for Payer: United Healthcare All Other HMO |
$17.87
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.38
|
| Rate for Payer: Vantage Medical Group Senior |
$30.38
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
IP
|
$35.74
|
|
|
Service Code
|
NDC 98193-000-17
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California Commercial |
$27.63
|
| Rate for Payer: Blue Shield of California EPN |
$18.01
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Central Health Plan Commercial |
$28.59
|
| Rate for Payer: Cigna of CA HMO |
$25.02
|
| Rate for Payer: Cigna of CA PPO |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.38
|
| Rate for Payer: Global Benefits Group Commercial |
$21.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.80
|
| Rate for Payer: Networks By Design Commercial |
$23.23
|
| Rate for Payer: Prime Health Services Commercial |
$30.38
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
IP
|
$4.73
|
|
|
Service Code
|
NDC 98193-00005
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.66
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Central Health Plan Commercial |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$3.31
|
| Rate for Payer: Cigna of CA PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$4.02
|
| Rate for Payer: Global Benefits Group Commercial |
$2.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
| Rate for Payer: Networks By Design Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.02
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
NDC 9994-0807-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: InnovAge PACE Commercial |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Riverside University Health System MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 99408-770-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$3.95
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Central Health Plan Commercial |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
NDC 9994-0807-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 99408-770-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Central Health Plan Commercial |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.60
|
| Rate for Payer: InnovAge PACE Commercial |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Riverside University Health System MISP |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
|
IP
|
$18.54
|
|
|
Service Code
|
NDC 69097-642-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$14.33
|
| Rate for Payer: Blue Shield of California EPN |
$9.34
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Central Health Plan Commercial |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$12.98
|
| Rate for Payer: Cigna of CA PPO |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Senior |
$7.42
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
|
OP
|
$18.54
|
|
|
Service Code
|
NDC 69097-642-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.89
|
| Rate for Payer: Blue Shield of California Commercial |
$11.33
|
| Rate for Payer: Blue Shield of California EPN |
$7.40
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Central Health Plan Commercial |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$12.98
|
| Rate for Payer: Cigna of CA PPO |
$12.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Senior |
$7.42
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.69
|
| Rate for Payer: InnovAge PACE Commercial |
$9.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.98
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
| Rate for Payer: Riverside University Health System MISP |
$7.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.27
|
| Rate for Payer: United Healthcare All Other HMO |
$9.27
|
| Rate for Payer: United Healthcare HMO Rider |
$9.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.76
|
| Rate for Payer: Vantage Medical Group Senior |
$15.76
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
|
IP
|
$19.28
|
|
|
Service Code
|
NDC 65862-301-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$17.35 |
| Rate for Payer: Adventist Health Commercial |
$3.86
|
| Rate for Payer: Blue Shield of California Commercial |
$14.90
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$10.60
|
| Rate for Payer: Central Health Plan Commercial |
$15.42
|
| Rate for Payer: Cigna of CA HMO |
$13.50
|
| Rate for Payer: Cigna of CA PPO |
$13.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.71
|
| Rate for Payer: EPIC Health Plan Senior |
$7.71
|
| Rate for Payer: Galaxy Health WC |
$16.39
|
| Rate for Payer: Global Benefits Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$14.46
|
| Rate for Payer: Networks By Design Commercial |
$12.53
|
| Rate for Payer: Prime Health Services Commercial |
$16.39
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
|
OP
|
$19.28
|
|
|
Service Code
|
NDC 65862-301-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$17.35 |
| Rate for Payer: Adventist Health Commercial |
$3.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Blue Shield of California Commercial |
$11.78
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$10.60
|
| Rate for Payer: Central Health Plan Commercial |
$15.42
|
| Rate for Payer: Cigna of CA HMO |
$13.50
|
| Rate for Payer: Cigna of CA PPO |
$13.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.71
|
| Rate for Payer: EPIC Health Plan Senior |
$7.71
|
| Rate for Payer: Galaxy Health WC |
$16.39
|
| Rate for Payer: Global Benefits Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.35
|
| Rate for Payer: InnovAge PACE Commercial |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.46
|
| Rate for Payer: Networks By Design Commercial |
$12.53
|
| Rate for Payer: Prime Health Services Commercial |
$16.39
|
| Rate for Payer: Riverside University Health System MISP |
$7.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.64
|
| Rate for Payer: United Healthcare All Other HMO |
$9.64
|
| Rate for Payer: United Healthcare HMO Rider |
$9.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.39
|
| Rate for Payer: Vantage Medical Group Senior |
$16.39
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]
|
Facility
|
OP
|
$88.09
|
|
|
Service Code
|
NDC 61958-2002-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$79.28 |
| Rate for Payer: Adventist Health Commercial |
$17.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.74
|
| Rate for Payer: Blue Shield of California Commercial |
$53.82
|
| Rate for Payer: Blue Shield of California EPN |
$35.15
|
| Rate for Payer: Cash Price |
$48.45
|
| Rate for Payer: Central Health Plan Commercial |
$70.47
|
| Rate for Payer: Cigna of CA HMO |
$61.66
|
| Rate for Payer: Cigna of CA PPO |
$61.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.24
|
| Rate for Payer: EPIC Health Plan Senior |
$35.24
|
| Rate for Payer: Galaxy Health WC |
$74.88
|
| Rate for Payer: Global Benefits Group Commercial |
$52.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.28
|
| Rate for Payer: InnovAge PACE Commercial |
$44.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.66
|
| Rate for Payer: Multiplan Commercial |
$66.07
|
| Rate for Payer: Networks By Design Commercial |
$57.26
|
| Rate for Payer: Prime Health Services Commercial |
$74.88
|
| Rate for Payer: Riverside University Health System MISP |
$35.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.05
|
| Rate for Payer: United Healthcare All Other HMO |
$44.05
|
| Rate for Payer: United Healthcare HMO Rider |
$44.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.88
|
| Rate for Payer: Vantage Medical Group Senior |
$74.88
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]
|
Facility
|
IP
|
$88.09
|
|
|
Service Code
|
NDC 61958-2002-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$79.28 |
| Rate for Payer: Adventist Health Commercial |
$17.62
|
| Rate for Payer: Blue Shield of California Commercial |
$68.09
|
| Rate for Payer: Blue Shield of California EPN |
$44.40
|
| Rate for Payer: Cash Price |
$48.45
|
| Rate for Payer: Central Health Plan Commercial |
$70.47
|
| Rate for Payer: Cigna of CA HMO |
$61.66
|
| Rate for Payer: Cigna of CA PPO |
$61.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.24
|
| Rate for Payer: EPIC Health Plan Senior |
$35.24
|
| Rate for Payer: Galaxy Health WC |
$74.88
|
| Rate for Payer: Global Benefits Group Commercial |
$52.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$66.07
|
| Rate for Payer: Networks By Design Commercial |
$57.26
|
| Rate for Payer: Prime Health Services Commercial |
$74.88
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J0750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.74
|
| Rate for Payer: InnovAge PACE Commercial |
$2.60
|
| Rate for Payer: InnovAge PACE Commercial |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Medicare |
$1.84
|
| Rate for Payer: Prime Health Services Medicare |
$1.84
|
| Rate for Payer: Riverside University Health System MISP |
$1.91
|
| Rate for Payer: Riverside University Health System MISP |
$1.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1.91
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: Cigna of CA HMO |
$4.08
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.73
|
| Rate for Payer: InnovAge PACE Commercial |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Riverside University Health System MISP |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-11
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.27
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.55
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Senior |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.12
|
| Rate for Payer: InnovAge PACE Commercial |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
| Rate for Payer: Riverside University Health System MISP |
$2.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.85
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare HMO Rider |
$2.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 0143-9786-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| 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 |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Senior |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 0143-9786-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| 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 |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Senior |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 43598-169-58
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.27
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.55
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Senior |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.12
|
| Rate for Payer: InnovAge PACE Commercial |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
| Rate for Payer: Riverside University Health System MISP |
$2.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.85
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare HMO Rider |
$2.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-58
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: Cigna of CA HMO |
$4.08
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.73
|
| Rate for Payer: InnovAge PACE Commercial |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Riverside University Health System MISP |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: Cigna of CA HMO |
$4.08
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.73
|
| Rate for Payer: InnovAge PACE Commercial |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Riverside University Health System MISP |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$5.69
|
|
|
Service Code
|
NDC 0143-9786-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.27
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.55
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Senior |
$2.28
|
| Rate for Payer: Galaxy Health WC |
$4.84
|
| Rate for Payer: Global Benefits Group Commercial |
$3.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.12
|
| Rate for Payer: InnovAge PACE Commercial |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$4.27
|
| Rate for Payer: Networks By Design Commercial |
$3.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.84
|
| Rate for Payer: Riverside University Health System MISP |
$2.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.85
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare HMO Rider |
$2.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.84
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 43598-078-11
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: Cigna of CA HMO |
$4.08
|
| Rate for Payer: Cigna of CA PPO |
$4.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.73
|
| Rate for Payer: InnovAge PACE Commercial |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Riverside University Health System MISP |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
