|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
|
OP
|
$45.93
|
|
|
Service Code
|
NDC 5201570023
|
| 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
|
|
|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
|
IP
|
$45.93
|
|
|
Service Code
|
NDC 5201570023
|
| 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
|
|
|
FILGRASTIM-AYOW 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE [233796]
|
Facility
|
IP
|
$381.60
|
|
|
Service Code
|
HCPCS Q5125
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Adventist Health Commercial |
$76.32
|
| Rate for Payer: Blue Shield of California Commercial |
$306.04
|
| Rate for Payer: Blue Shield of California EPN |
$192.33
|
| Rate for Payer: Cash Price |
$171.72
|
| Rate for Payer: Central Health Plan Commercial |
$305.28
|
| Rate for Payer: Cigna of CA HMO |
$267.12
|
| Rate for Payer: Cigna of CA PPO |
$267.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.64
|
| Rate for Payer: EPIC Health Plan Senior |
$152.64
|
| Rate for Payer: Galaxy Health WC |
$324.36
|
| Rate for Payer: Global Benefits Group Commercial |
$228.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$343.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$242.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$286.20
|
| Rate for Payer: Networks By Design Commercial |
$190.80
|
| Rate for Payer: Prime Health Services Commercial |
$324.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.21
|
| Rate for Payer: United Healthcare All Other HMO |
$139.40
|
| Rate for Payer: United Healthcare HMO Rider |
$136.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.97
|
|
|
FILGRASTIM-AYOW 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE [233796]
|
Facility
|
OP
|
$381.60
|
|
|
Service Code
|
HCPCS Q5125
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Adventist Health Commercial |
$76.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$171.72
|
| Rate for Payer: Cash Price |
$171.72
|
| Rate for Payer: Central Health Plan Commercial |
$305.28
|
| Rate for Payer: Cigna of CA HMO |
$267.12
|
| Rate for Payer: Cigna of CA PPO |
$267.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$324.36
|
| Rate for Payer: Global Benefits Group Commercial |
$228.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$343.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$242.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$286.20
|
| Rate for Payer: Networks By Design Commercial |
$190.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$324.36
|
| Rate for Payer: Prime Health Services Medicare |
$0.33
|
| Rate for Payer: Riverside University Health System MISP |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$228.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$228.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.21
|
| Rate for Payer: United Healthcare All Other HMO |
$139.40
|
| Rate for Payer: United Healthcare HMO Rider |
$136.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
FILGRASTIM-AYOW 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE [233797]
|
Facility
|
IP
|
$381.60
|
|
|
Service Code
|
HCPCS Q5125
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Adventist Health Commercial |
$76.32
|
| Rate for Payer: Blue Shield of California Commercial |
$306.04
|
| Rate for Payer: Blue Shield of California EPN |
$192.33
|
| Rate for Payer: Cash Price |
$171.72
|
| Rate for Payer: Central Health Plan Commercial |
$305.28
|
| Rate for Payer: Cigna of CA HMO |
$267.12
|
| Rate for Payer: Cigna of CA PPO |
$267.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.64
|
| Rate for Payer: EPIC Health Plan Senior |
$152.64
|
| Rate for Payer: Galaxy Health WC |
$324.36
|
| Rate for Payer: Global Benefits Group Commercial |
$228.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$343.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$242.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$286.20
|
| Rate for Payer: Networks By Design Commercial |
$190.80
|
| Rate for Payer: Prime Health Services Commercial |
$324.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.21
|
| Rate for Payer: United Healthcare All Other HMO |
$139.40
|
| Rate for Payer: United Healthcare HMO Rider |
$136.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.97
|
|
|
FILGRASTIM-AYOW 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE [233797]
|
Facility
|
OP
|
$381.60
|
|
|
Service Code
|
HCPCS Q5125
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Adventist Health Commercial |
$76.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$171.72
|
| Rate for Payer: Cash Price |
$171.72
|
| Rate for Payer: Central Health Plan Commercial |
$305.28
|
| Rate for Payer: Cigna of CA HMO |
$267.12
|
| Rate for Payer: Cigna of CA PPO |
$267.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$324.36
|
| Rate for Payer: Global Benefits Group Commercial |
$228.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$343.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$242.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$286.20
|
| Rate for Payer: Networks By Design Commercial |
$190.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$324.36
|
| Rate for Payer: Prime Health Services Medicare |
$0.33
|
| Rate for Payer: Riverside University Health System MISP |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$228.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$228.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.21
|
| Rate for Payer: United Healthcare All Other HMO |
$139.40
|
| Rate for Payer: United Healthcare HMO Rider |
$136.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [211102]
|
Facility
|
OP
|
$658.47
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$592.62 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Central Health Plan Commercial |
$526.78
|
| Rate for Payer: Cigna of CA HMO |
$460.93
|
| Rate for Payer: Cigna of CA PPO |
$460.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$460.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$559.70
|
| Rate for Payer: Global Benefits Group Commercial |
$395.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$592.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$418.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: Networks By Design Commercial |
$329.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$559.70
|
| Rate for Payer: Prime Health Services Medicare |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$395.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.12
|
| Rate for Payer: United Healthcare All Other HMO |
$240.54
|
| Rate for Payer: United Healthcare HMO Rider |
$235.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [211102]
|
Facility
|
IP
|
$658.47
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.69 |
| Max. Negotiated Rate |
$592.62 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Blue Shield of California Commercial |
$528.09
|
| Rate for Payer: Blue Shield of California EPN |
$331.87
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Central Health Plan Commercial |
$526.78
|
| Rate for Payer: Cigna of CA HMO |
$460.93
|
| Rate for Payer: Cigna of CA PPO |
$460.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$460.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.39
|
| Rate for Payer: EPIC Health Plan Senior |
$263.39
|
| Rate for Payer: Galaxy Health WC |
$559.70
|
| Rate for Payer: Global Benefits Group Commercial |
$395.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$592.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$418.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.69
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: Networks By Design Commercial |
$329.24
|
| Rate for Payer: Prime Health Services Commercial |
$559.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.12
|
| Rate for Payer: United Healthcare All Other HMO |
$240.54
|
| Rate for Payer: United Healthcare HMO Rider |
$235.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.65
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [211101]
|
Facility
|
OP
|
$658.47
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$592.62 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Central Health Plan Commercial |
$526.78
|
| Rate for Payer: Cigna of CA HMO |
$460.93
|
| Rate for Payer: Cigna of CA PPO |
$460.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$460.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$559.70
|
| Rate for Payer: Global Benefits Group Commercial |
$395.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$592.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$418.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: Networks By Design Commercial |
$329.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$559.70
|
| Rate for Payer: Prime Health Services Medicare |
$0.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$395.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.12
|
| Rate for Payer: United Healthcare All Other HMO |
$240.54
|
| Rate for Payer: United Healthcare HMO Rider |
$235.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [211101]
|
Facility
|
IP
|
$658.47
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.69 |
| Max. Negotiated Rate |
$592.62 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Blue Shield of California Commercial |
$528.09
|
| Rate for Payer: Blue Shield of California EPN |
$331.87
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Central Health Plan Commercial |
$526.78
|
| Rate for Payer: Cigna of CA HMO |
$460.93
|
| Rate for Payer: Cigna of CA PPO |
$460.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$460.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.39
|
| Rate for Payer: EPIC Health Plan Senior |
$263.39
|
| Rate for Payer: Galaxy Health WC |
$559.70
|
| Rate for Payer: Global Benefits Group Commercial |
$395.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$592.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$418.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.69
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: Networks By Design Commercial |
$329.24
|
| Rate for Payer: Prime Health Services Commercial |
$559.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.12
|
| Rate for Payer: United Healthcare All Other HMO |
$240.54
|
| Rate for Payer: United Healthcare HMO Rider |
$235.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.65
|
|
|
FINASTERIDE 5 MG TABLET [10037]
|
Facility
|
IP
|
$0.68
|
|
|
Service Code
|
HCPCS S0138
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
FINASTERIDE 5 MG TABLET [10037]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
HCPCS S0138
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$0.58
|
| Rate for Payer: Riverside University Health System MISP |
$0.27
|
| Rate for Payer: Riverside University Health System MISP |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.58
|
|
|
FINASTERIDE (PROSCAR) CRUSHED TABLET IN WATER [4081461]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS S0138
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
FINASTERIDE (PROSCAR) CRUSHED TABLET IN WATER [4081461]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS S0138
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
FINERENONE 10 MG TABLET [232074]
|
Facility
|
OP
|
$28.62
|
|
|
Service Code
|
NDC 5041954001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.65
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.42
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: Cigna of CA HMO |
$20.03
|
| Rate for Payer: Cigna of CA PPO |
$20.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.03
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
| Rate for Payer: Riverside University Health System MISP |
$11.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other HMO |
$14.31
|
| Rate for Payer: United Healthcare HMO Rider |
$14.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.33
|
| Rate for Payer: Vantage Medical Group Senior |
$24.33
|
|
|
FINERENONE 10 MG TABLET [232074]
|
Facility
|
IP
|
$28.62
|
|
|
Service Code
|
NDC 5041954001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Blue Shield of California Commercial |
$22.95
|
| Rate for Payer: Blue Shield of California EPN |
$14.42
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: Cigna of CA HMO |
$20.03
|
| Rate for Payer: Cigna of CA PPO |
$20.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
|
|
FINERENONE 20 MG TABLET [232075]
|
Facility
|
OP
|
$28.62
|
|
|
Service Code
|
NDC 5041954101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.65
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.42
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: Cigna of CA HMO |
$20.03
|
| Rate for Payer: Cigna of CA PPO |
$20.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.03
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
| Rate for Payer: Riverside University Health System MISP |
$11.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other HMO |
$14.31
|
| Rate for Payer: United Healthcare HMO Rider |
$14.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.33
|
| Rate for Payer: Vantage Medical Group Senior |
$24.33
|
|
|
FINERENONE 20 MG TABLET [232075]
|
Facility
|
IP
|
$28.62
|
|
|
Service Code
|
NDC 5041954101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Blue Shield of California Commercial |
$22.95
|
| Rate for Payer: Blue Shield of California EPN |
$14.42
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: Cigna of CA HMO |
$20.03
|
| Rate for Payer: Cigna of CA PPO |
$20.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
|
|
FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 46200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,569.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,551.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Preferred Health Network WC |
$5,665.21
|
| Rate for Payer: Prime Health Services Medicare |
$3,784.16
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,926.96
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO IN ABSENCE OF PREVIOUS SURGERY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 66170
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,160.33 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,968.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,160.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,281.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,155.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
FLAP; ISLAND PEDICLE REQUIRING IDENTIFICATION AND DISSECTION OF AN ANATOMICALLY NAMED AXIAL VESSEL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
FLAVORX LIQUID [100560]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 8606700047
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
FLAVORX LIQUID [100560]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 7857300074
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
FLAVORX LIQUID [100560]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 7857300074
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
FLAVORX LIQUID [100560]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 8606700047
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
