|
FERROUS SULFATE 324/325 MG (65 MG IRON) TABLET. [4083077]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 6936716620
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
FERROUS SULFATE 324/325 MG (65 MG IRON) TABLET. [4083077]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0904759160
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0904759160
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0904759080
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0904759080
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET [3074]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0904759160
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
FERUMOXIDES 28 MG IRON-32 MG/ML SUBCUTANEOUS SUSPENSION [241631]
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS A9697
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,254.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,567.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,379.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,379.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$319.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.92
|
| Rate for Payer: Blue Shield of California Commercial |
$415.80
|
| Rate for Payer: Blue Shield of California EPN |
$262.02
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Central Health Plan Commercial |
$528.00
|
| Rate for Payer: Cigna of CA HMO |
$422.40
|
| Rate for Payer: Cigna of CA PPO |
$488.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,567.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,379.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,379.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,069.10
|
| Rate for Payer: EPIC Health Plan Senior |
$1,379.40
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$594.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,056.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$419.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,755.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,680.36
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,254.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,329.24
|
| Rate for Payer: Riverside University Health System MISP |
$1,379.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$396.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$396.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.70
|
| Rate for Payer: United Healthcare All Other HMO |
$241.10
|
| Rate for Payer: United Healthcare HMO Rider |
$235.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,254.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,567.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,379.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,379.40
|
|
|
FERUMOXIDES 28 MG IRON-32 MG/ML SUBCUTANEOUS SUSPENSION [241631]
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS A9697
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Blue Shield of California Commercial |
$529.32
|
| Rate for Payer: Blue Shield of California EPN |
$332.64
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Central Health Plan Commercial |
$528.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Senior |
$264.00
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$594.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$419.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$389.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.70
|
| Rate for Payer: United Healthcare All Other HMO |
$241.10
|
| Rate for Payer: United Healthcare HMO Rider |
$235.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.15
|
|
|
FESOTERODINE ER 4 MG TABLET,EXTENDED RELEASE 24 HR [96973]
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
NDC 0069024230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Adventist Health Commercial |
$2.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.75
|
| Rate for Payer: Blue Shield of California Commercial |
$7.35
|
| Rate for Payer: Blue Shield of California EPN |
$4.63
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Central Health Plan Commercial |
$9.28
|
| Rate for Payer: Cigna of CA HMO |
$8.12
|
| Rate for Payer: Cigna of CA PPO |
$8.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.64
|
| Rate for Payer: EPIC Health Plan Senior |
$4.64
|
| Rate for Payer: Galaxy Health WC |
$9.86
|
| Rate for Payer: Global Benefits Group Commercial |
$6.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.12
|
| Rate for Payer: Multiplan Commercial |
$8.70
|
| Rate for Payer: Networks By Design Commercial |
$7.54
|
| Rate for Payer: Prime Health Services Commercial |
$9.86
|
| Rate for Payer: Riverside University Health System MISP |
$4.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.80
|
| Rate for Payer: United Healthcare All Other HMO |
$5.80
|
| Rate for Payer: United Healthcare HMO Rider |
$5.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.86
|
| Rate for Payer: Vantage Medical Group Senior |
$9.86
|
|
|
FESOTERODINE ER 4 MG TABLET,EXTENDED RELEASE 24 HR [96973]
|
Facility
|
IP
|
$11.60
|
|
|
Service Code
|
NDC 0069024230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Adventist Health Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California Commercial |
$9.30
|
| Rate for Payer: Blue Shield of California EPN |
$5.85
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Central Health Plan Commercial |
$9.28
|
| Rate for Payer: Cigna of CA HMO |
$8.12
|
| Rate for Payer: Cigna of CA PPO |
$8.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.64
|
| Rate for Payer: EPIC Health Plan Senior |
$4.64
|
| Rate for Payer: Galaxy Health WC |
$9.86
|
| Rate for Payer: Global Benefits Group Commercial |
$6.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$8.70
|
| Rate for Payer: Networks By Design Commercial |
$7.54
|
| Rate for Payer: Prime Health Services Commercial |
$9.86
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$23,363.38
|
|
|
Service Code
|
MSDRG 864
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$23,363.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,363.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,091.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,129.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,688.92
|
| Rate for Payer: EPIC Health Plan Senior |
$14,459.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,144.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,402.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,614.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,144.80
|
| Rate for Payer: Prime Health Services Medicare |
$13,933.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$12,244.26
|
|
|
Service Code
|
APR-DRG 7223
|
| Min. Negotiated Rate |
$7,733.22 |
| Max. Negotiated Rate |
$12,244.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,733.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,215.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,244.26
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$9,023.58
|
|
|
Service Code
|
APR-DRG 7222
|
| Min. Negotiated Rate |
$5,699.10 |
| Max. Negotiated Rate |
$9,023.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,699.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,791.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,023.58
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$6,435.34
|
|
|
Service Code
|
APR-DRG 7221
|
| Min. Negotiated Rate |
$4,064.42 |
| Max. Negotiated Rate |
$6,435.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,064.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,843.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,435.34
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$16,945.38
|
|
|
Service Code
|
APR-DRG 7224
|
| Min. Negotiated Rate |
$10,702.34 |
| Max. Negotiated Rate |
$16,945.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,702.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,753.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,945.38
|
|
|
FEXOFENADINE 180 MG TABLET [25425]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 4116741203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Riverside University Health System MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
FEXOFENADINE 180 MG TABLET [25425]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 4116741203
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
FIDAXOMICIN 200 MG TABLET [153338]
|
Facility
|
IP
|
$312.30
|
|
|
Service Code
|
NDC 5201508001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.46 |
| Max. Negotiated Rate |
$281.07 |
| Rate for Payer: Adventist Health Commercial |
$62.46
|
| Rate for Payer: Blue Shield of California Commercial |
$250.46
|
| Rate for Payer: Blue Shield of California EPN |
$157.40
|
| Rate for Payer: Cash Price |
$140.54
|
| Rate for Payer: Central Health Plan Commercial |
$249.84
|
| Rate for Payer: Cigna of CA HMO |
$218.61
|
| Rate for Payer: Cigna of CA PPO |
$218.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.92
|
| Rate for Payer: EPIC Health Plan Senior |
$124.92
|
| Rate for Payer: Galaxy Health WC |
$265.45
|
| Rate for Payer: Global Benefits Group Commercial |
$187.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.46
|
| Rate for Payer: Multiplan Commercial |
$234.22
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.45
|
|
|
FIDAXOMICIN 200 MG TABLET [153338]
|
Facility
|
OP
|
$269.83
|
|
|
Service Code
|
NDC 0480259634
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$242.85 |
| Rate for Payer: Adventist Health Commercial |
$53.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.96
|
| Rate for Payer: Blue Shield of California Commercial |
$171.07
|
| Rate for Payer: Blue Shield of California EPN |
$107.66
|
| Rate for Payer: Cash Price |
$121.42
|
| Rate for Payer: Central Health Plan Commercial |
$215.86
|
| Rate for Payer: Cigna of CA HMO |
$188.88
|
| Rate for Payer: Cigna of CA PPO |
$188.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$188.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.93
|
| Rate for Payer: EPIC Health Plan Senior |
$107.93
|
| Rate for Payer: Galaxy Health WC |
$229.36
|
| Rate for Payer: Global Benefits Group Commercial |
$161.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.88
|
| Rate for Payer: Multiplan Commercial |
$202.37
|
| Rate for Payer: Networks By Design Commercial |
$175.39
|
| Rate for Payer: Prime Health Services Commercial |
$229.36
|
| Rate for Payer: Riverside University Health System MISP |
$107.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.91
|
| Rate for Payer: United Healthcare All Other HMO |
$134.91
|
| Rate for Payer: United Healthcare HMO Rider |
$134.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.36
|
| Rate for Payer: Vantage Medical Group Senior |
$229.36
|
|
|
FIDAXOMICIN 200 MG TABLET [153338]
|
Facility
|
IP
|
$188.88
|
|
|
Service Code
|
NDC 6050548332
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.78 |
| Max. Negotiated Rate |
$169.99 |
| Rate for Payer: Adventist Health Commercial |
$37.78
|
| Rate for Payer: Blue Shield of California Commercial |
$151.48
|
| Rate for Payer: Blue Shield of California EPN |
$95.20
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Central Health Plan Commercial |
$151.10
|
| Rate for Payer: Cigna of CA HMO |
$132.22
|
| Rate for Payer: Cigna of CA PPO |
$132.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.55
|
| Rate for Payer: EPIC Health Plan Senior |
$75.55
|
| Rate for Payer: Galaxy Health WC |
$160.55
|
| Rate for Payer: Global Benefits Group Commercial |
$113.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$119.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.78
|
| Rate for Payer: Multiplan Commercial |
$141.66
|
| Rate for Payer: Networks By Design Commercial |
$122.77
|
| Rate for Payer: Prime Health Services Commercial |
$160.55
|
|
|
FIDAXOMICIN 200 MG TABLET [153338]
|
Facility
|
OP
|
$188.88
|
|
|
Service Code
|
NDC 6050548332
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.78 |
| Max. Negotiated Rate |
$169.99 |
| Rate for Payer: Adventist Health Commercial |
$37.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.87
|
| Rate for Payer: Blue Shield of California Commercial |
$119.75
|
| Rate for Payer: Blue Shield of California EPN |
$75.36
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Central Health Plan Commercial |
$151.10
|
| Rate for Payer: Cigna of CA HMO |
$132.22
|
| Rate for Payer: Cigna of CA PPO |
$132.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.55
|
| Rate for Payer: EPIC Health Plan Senior |
$75.55
|
| Rate for Payer: Galaxy Health WC |
$160.55
|
| Rate for Payer: Global Benefits Group Commercial |
$113.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$119.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$132.22
|
| Rate for Payer: Multiplan Commercial |
$141.66
|
| Rate for Payer: Networks By Design Commercial |
$122.77
|
| Rate for Payer: Prime Health Services Commercial |
$160.55
|
| Rate for Payer: Riverside University Health System MISP |
$75.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.44
|
| Rate for Payer: United Healthcare All Other HMO |
$94.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.55
|
| Rate for Payer: Vantage Medical Group Senior |
$160.55
|
|
|
FIDAXOMICIN 200 MG TABLET [153338]
|
Facility
|
IP
|
$269.83
|
|
|
Service Code
|
NDC 0480259634
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$242.85 |
| Rate for Payer: Adventist Health Commercial |
$53.97
|
| Rate for Payer: Blue Shield of California Commercial |
$216.40
|
| Rate for Payer: Blue Shield of California EPN |
$135.99
|
| Rate for Payer: Cash Price |
$121.42
|
| Rate for Payer: Central Health Plan Commercial |
$215.86
|
| Rate for Payer: Cigna of CA HMO |
$188.88
|
| Rate for Payer: Cigna of CA PPO |
$188.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$188.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.93
|
| Rate for Payer: EPIC Health Plan Senior |
$107.93
|
| Rate for Payer: Galaxy Health WC |
$229.36
|
| Rate for Payer: Global Benefits Group Commercial |
$161.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.97
|
| Rate for Payer: Multiplan Commercial |
$202.37
|
| Rate for Payer: Networks By Design Commercial |
$175.39
|
| Rate for Payer: Prime Health Services Commercial |
$229.36
|
|
|
FIDAXOMICIN 200 MG TABLET [153338]
|
Facility
|
OP
|
$312.30
|
|
|
Service Code
|
NDC 5201508001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.46 |
| Max. Negotiated Rate |
$281.07 |
| Rate for Payer: Adventist Health Commercial |
$62.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.66
|
| Rate for Payer: Blue Shield of California Commercial |
$198.00
|
| Rate for Payer: Blue Shield of California EPN |
$124.61
|
| Rate for Payer: Cash Price |
$140.54
|
| Rate for Payer: Central Health Plan Commercial |
$249.84
|
| Rate for Payer: Cigna of CA HMO |
$218.61
|
| Rate for Payer: Cigna of CA PPO |
$218.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.92
|
| Rate for Payer: EPIC Health Plan Senior |
$124.92
|
| Rate for Payer: Galaxy Health WC |
$265.45
|
| Rate for Payer: Global Benefits Group Commercial |
$187.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$218.61
|
| Rate for Payer: Multiplan Commercial |
$234.22
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.45
|
| Rate for Payer: Riverside University Health System MISP |
$124.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.15
|
| Rate for Payer: United Healthcare All Other HMO |
$156.15
|
| Rate for Payer: United Healthcare HMO Rider |
$156.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.45
|
| Rate for Payer: Vantage Medical Group Senior |
$265.45
|
|
|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
|
IP
|
$45.93
|
|
|
Service Code
|
NDC 5201570022
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$41.34 |
| Rate for Payer: Adventist Health Commercial |
$9.19
|
| Rate for Payer: Blue Shield of California Commercial |
$36.84
|
| Rate for Payer: Blue Shield of California EPN |
$23.15
|
| Rate for Payer: Cash Price |
$20.67
|
| Rate for Payer: Central Health Plan Commercial |
$36.74
|
| Rate for Payer: Cigna of CA HMO |
$32.15
|
| Rate for Payer: Cigna of CA PPO |
$32.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.04
|
| Rate for Payer: Global Benefits Group Commercial |
$27.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.19
|
| Rate for Payer: Multiplan Commercial |
$34.45
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.04
|
|
|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
|
OP
|
$45.93
|
|
|
Service Code
|
NDC 5201570022
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$41.34 |
| Rate for Payer: Adventist Health Commercial |
$9.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.72
|
| Rate for Payer: Blue Shield of California Commercial |
$29.12
|
| Rate for Payer: Blue Shield of California EPN |
$18.33
|
| Rate for Payer: Cash Price |
$20.67
|
| Rate for Payer: Central Health Plan Commercial |
$36.74
|
| Rate for Payer: Cigna of CA HMO |
$32.15
|
| Rate for Payer: Cigna of CA PPO |
$32.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.04
|
| Rate for Payer: Global Benefits Group Commercial |
$27.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.15
|
| Rate for Payer: Multiplan Commercial |
$34.45
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.04
|
| Rate for Payer: Riverside University Health System MISP |
$18.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.96
|
| Rate for Payer: United Healthcare All Other HMO |
$22.96
|
| Rate for Payer: United Healthcare HMO Rider |
$22.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.04
|
| Rate for Payer: Vantage Medical Group Senior |
$39.04
|
|
