|
AMIKACIN 500 MG/2 ML INJECTION SOLUTION [121291]
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
HCPCS J0278
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$0.93
|
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3.61
|
| Rate for Payer: Blue Shield of California EPN |
$2.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.34
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Central Health Plan Commercial |
$3.72
|
| Rate for Payer: Central Health Plan Commercial |
$3.60
|
| Rate for Payer: Central Health Plan Commercial |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA HMO |
$3.25
|
| Rate for Payer: Cigna of CA PPO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.25
|
| Rate for Payer: Cigna of CA PPO |
$3.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.92
|
| Rate for Payer: Galaxy Health WC |
$3.95
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Galaxy Health WC |
$4.08
|
| Rate for Payer: Global Benefits Group Commercial |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$2.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$3.38
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$2.33
|
| 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 |
$3.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.61
|
| Rate for Payer: United Healthcare HMO Rider |
$1.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.47
|
|
|
AMILORIDE 5 MG TABLET [391]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 0574029201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| 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: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| 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: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$0.23
|
| 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 0574029201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| 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
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION [9062]
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
NDC 3172203523
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Central Health Plan Commercial |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
|
|
AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION [9062]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 3172203523
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Central Health Plan Commercial |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
| Rate for Payer: Riverside University Health System MISP |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Vantage Medical Group Senior |
$0.97
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]
|
Facility
|
IP
|
$0.65
|
|
|
Service Code
|
HCPCS J0281
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
|
|
AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION [403]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
HCPCS J0281
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
|
OP
|
$7.16
|
|
|
Service Code
|
NDC 6968011530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.16
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.86
|
| 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: Dignity Health Medi-Cal |
$6.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$4.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.01
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$6.09
|
| 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
|
OP
|
$28.70
|
|
|
Service Code
|
NDC 6068773995
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.69
|
| Rate for Payer: Blue Shield of California Commercial |
$18.20
|
| Rate for Payer: Blue Shield of California EPN |
$11.45
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Central Health Plan Commercial |
$22.96
|
| Rate for Payer: Cigna of CA HMO |
$20.09
|
| Rate for Payer: Cigna of CA PPO |
$20.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$24.39
|
| Rate for Payer: Global Benefits Group Commercial |
$17.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$21.52
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.39
|
| Rate for Payer: Riverside University Health System MISP |
$11.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.35
|
| Rate for Payer: United Healthcare All Other HMO |
$14.35
|
| Rate for Payer: United Healthcare HMO Rider |
$14.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$24.39
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
|
IP
|
$7.16
|
|
|
Service Code
|
NDC 7037710211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$4.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| 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
|
IP
|
$7.16
|
|
|
Service Code
|
NDC 6968011530
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$4.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| 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
|
$28.70
|
|
|
Service Code
|
NDC 6068773925
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.69
|
| Rate for Payer: Blue Shield of California Commercial |
$18.20
|
| Rate for Payer: Blue Shield of California EPN |
$11.45
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Central Health Plan Commercial |
$22.96
|
| Rate for Payer: Cigna of CA HMO |
$20.09
|
| Rate for Payer: Cigna of CA PPO |
$20.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$24.39
|
| Rate for Payer: Global Benefits Group Commercial |
$17.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$21.52
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.39
|
| Rate for Payer: Riverside University Health System MISP |
$11.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.35
|
| Rate for Payer: United Healthcare All Other HMO |
$14.35
|
| Rate for Payer: United Healthcare HMO Rider |
$14.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$24.39
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
|
IP
|
$28.70
|
|
|
Service Code
|
NDC 6068773925
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California Commercial |
$23.02
|
| Rate for Payer: Blue Shield of California EPN |
$14.46
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Central Health Plan Commercial |
$22.96
|
| Rate for Payer: Cigna of CA HMO |
$20.09
|
| Rate for Payer: Cigna of CA PPO |
$20.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$24.39
|
| Rate for Payer: Global Benefits Group Commercial |
$17.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$21.52
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.39
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
|
IP
|
$28.70
|
|
|
Service Code
|
NDC 6068773995
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California Commercial |
$23.02
|
| Rate for Payer: Blue Shield of California EPN |
$14.46
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Central Health Plan Commercial |
$22.96
|
| Rate for Payer: Cigna of CA HMO |
$20.09
|
| Rate for Payer: Cigna of CA PPO |
$20.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$24.39
|
| Rate for Payer: Global Benefits Group Commercial |
$17.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$21.52
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.39
|
|
|
AMINOCAPROIC ACID 500 MG TABLET [9063]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 7220504930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.43
|
| Rate for Payer: Blue Shield of California EPN |
$6.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.67
|
| 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
|
$13.00
|
|
|
Service Code
|
NDC 7220504930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.56
|
| Rate for Payer: Blue Shield of California Commercial |
$8.24
|
| Rate for Payer: Blue Shield of California EPN |
$5.19
|
| 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: Dignity Health Medi-Cal |
$11.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.10
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$11.05
|
| 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
|
OP
|
$7.16
|
|
|
Service Code
|
NDC 7037710211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.16
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.86
|
| 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: Dignity Health Medi-Cal |
$6.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$4.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.01
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$6.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Vantage Medical Group Senior |
$6.09
|
|
|
AMINOLEVULINIC ACID HCL 30 MG/ML ORAL SOLUTION [222763]
|
Facility
|
IP
|
$3,835.20
|
|
|
Service Code
|
NDC 5913723101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$767.04 |
| Max. Negotiated Rate |
$3,451.68 |
| Rate for Payer: Adventist Health Commercial |
$767.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3,075.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,932.94
|
| Rate for Payer: Cash Price |
$1,725.84
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.16
|
| Rate for Payer: Cigna of CA HMO |
$2,684.64
|
| Rate for Payer: Cigna of CA PPO |
$2,684.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.08
|
| Rate for Payer: Galaxy Health WC |
$3,259.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.04
|
| Rate for Payer: Multiplan Commercial |
$2,876.40
|
| Rate for Payer: Networks By Design Commercial |
$2,492.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.92
|
|
|
AMINOLEVULINIC ACID HCL 30 MG/ML ORAL SOLUTION [222763]
|
Facility
|
OP
|
$3,835.20
|
|
|
Service Code
|
NDC 5913723101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$767.04 |
| Max. Negotiated Rate |
$3,451.68 |
| Rate for Payer: Adventist Health Commercial |
$767.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,329.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,259.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,109.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,876.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,857.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,230.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,431.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,530.24
|
| Rate for Payer: Cash Price |
$1,725.84
|
| Rate for Payer: Central Health Plan Commercial |
$3,068.16
|
| Rate for Payer: Cigna of CA HMO |
$2,684.64
|
| Rate for Payer: Cigna of CA PPO |
$2,684.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,259.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,259.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,259.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1,534.08
|
| Rate for Payer: Galaxy Health WC |
$3,259.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2,301.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,451.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,435.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,392.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,262.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.64
|
| Rate for Payer: Multiplan Commercial |
$2,876.40
|
| Rate for Payer: Networks By Design Commercial |
$2,492.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,259.92
|
| Rate for Payer: Riverside University Health System MISP |
$1,534.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,301.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,301.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,917.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,917.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,917.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,259.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,259.92
|
| Rate for Payer: Vantage Medical Group Senior |
$3,259.92
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION [407]
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$68.47 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$14.41
|
| Rate for Payer: Blue Shield of California EPN |
$13.10
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.32
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: Riverside University Health System MISP |
$1.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION [407]
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.32
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION CDL ONLY [4084072]
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$68.47 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$14.41
|
| Rate for Payer: Blue Shield of California EPN |
$13.10
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.32
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: Riverside University Health System MISP |
$1.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION CDL ONLY [4084072]
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.32
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION (RAD) [4084071]
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.32
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
|
|
AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION (RAD) [4084071]
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$68.47 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$14.41
|
| Rate for Payer: Blue Shield of California EPN |
$13.10
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.32
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: Riverside University Health System MISP |
$1.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
