|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.10
|
| Rate for Payer: Cash Price |
$16.48
|
| Rate for Payer: Central Health Plan Commercial |
$23.97
|
| Rate for Payer: Cigna of CA HMO |
$20.97
|
| Rate for Payer: Cigna of CA PPO |
$20.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.98
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$25.47
|
| Rate for Payer: Global Benefits Group Commercial |
$17.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$22.47
|
| Rate for Payer: Networks By Design Commercial |
$19.47
|
| Rate for Payer: Prime Health Services Commercial |
$25.47
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.60
|
| Rate for Payer: Blue Shield of California Commercial |
$18.31
|
| Rate for Payer: Blue Shield of California EPN |
$11.95
|
| Rate for Payer: Cash Price |
$16.48
|
| Rate for Payer: Central Health Plan Commercial |
$23.97
|
| Rate for Payer: Cigna of CA HMO |
$20.97
|
| Rate for Payer: Cigna of CA PPO |
$20.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.98
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$25.47
|
| Rate for Payer: Global Benefits Group Commercial |
$17.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.96
|
| Rate for Payer: InnovAge PACE Commercial |
$14.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$22.47
|
| Rate for Payer: Networks By Design Commercial |
$19.47
|
| Rate for Payer: Prime Health Services Commercial |
$25.47
|
| Rate for Payer: Riverside University Health System MISP |
$11.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.98
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.47
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
EUCALYPTUS OIL-ALOE EXTR-LAVENDER,ROSEMARY OIL-PETROLATUM TOP OINTMENT [9125]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 2390000617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| 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 |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
EUCALYPTUS OIL-ALOE EXTR-LAVENDER,ROSEMARY OIL-PETROLATUM TOP OINTMENT [9125]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 2390000617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Adventist Health Commercial |
$7.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Central Health Plan Commercial |
$31.62
|
| Rate for Payer: Cigna of CA HMO |
$27.66
|
| Rate for Payer: Cigna of CA PPO |
$27.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.81
|
| Rate for Payer: EPIC Health Plan Senior |
$15.81
|
| Rate for Payer: Galaxy Health WC |
$33.59
|
| Rate for Payer: Global Benefits Group Commercial |
$23.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.02
|
| Rate for Payer: InnovAge PACE Commercial |
$19.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.66
|
| Rate for Payer: Multiplan Commercial |
$29.64
|
| Rate for Payer: Networks By Design Commercial |
$19.76
|
| Rate for Payer: Prime Health Services Commercial |
$33.59
|
| Rate for Payer: Riverside University Health System MISP |
$15.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.59
|
| Rate for Payer: Vantage Medical Group Senior |
$33.59
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
|
IP
|
$39.52
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Adventist Health Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California Commercial |
$30.55
|
| Rate for Payer: Blue Shield of California EPN |
$19.92
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Central Health Plan Commercial |
$31.62
|
| Rate for Payer: Cigna of CA HMO |
$27.66
|
| Rate for Payer: Cigna of CA PPO |
$27.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.81
|
| Rate for Payer: EPIC Health Plan Senior |
$15.81
|
| Rate for Payer: Galaxy Health WC |
$33.59
|
| Rate for Payer: Global Benefits Group Commercial |
$23.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$29.64
|
| Rate for Payer: Networks By Design Commercial |
$19.76
|
| Rate for Payer: Prime Health Services Commercial |
$33.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.94
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Adventist Health Commercial |
$2.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.53
|
| Rate for Payer: Cigna of CA HMO |
$9.21
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$9.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Senior |
$5.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$11.19
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.02
|
| Rate for Payer: InnovAge PACE Commercial |
$6.58
|
| Rate for Payer: InnovAge PACE Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$9.87
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Prime Health Services Commercial |
$11.19
|
| Rate for Payer: Riverside University Health System MISP |
$5.26
|
| Rate for Payer: Riverside University Health System MISP |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.94
|
| Rate for Payer: United Healthcare All Other HMO |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$4.81
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$11.19
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Adventist Health Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1.93
|
| Rate for Payer: Blue Shield of California Commercial |
$10.17
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.26
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.53
|
| Rate for Payer: Cigna of CA HMO |
$9.21
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$9.21
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$11.19
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.63
|
| Rate for Payer: Multiplan Commercial |
$9.87
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Prime Health Services Commercial |
$11.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$4.81
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
|
IP
|
$26.32
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$5.27
|
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Blue Shield of California Commercial |
$20.35
|
| Rate for Payer: Blue Shield of California Commercial |
$14.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7.61
|
| Rate for Payer: Blue Shield of California Commercial |
$20.38
|
| Rate for Payer: Blue Shield of California EPN |
$13.27
|
| Rate for Payer: Blue Shield of California EPN |
$9.59
|
| Rate for Payer: Blue Shield of California EPN |
$13.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.47
|
| Rate for Payer: Central Health Plan Commercial |
$7.87
|
| Rate for Payer: Central Health Plan Commercial |
$21.06
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: Central Health Plan Commercial |
$21.09
|
| Rate for Payer: Cigna of CA HMO |
$18.42
|
| Rate for Payer: Cigna of CA HMO |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$18.42
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.53
|
| Rate for Payer: EPIC Health Plan Senior |
$10.53
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$10.54
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$22.37
|
| Rate for Payer: Galaxy Health WC |
$22.41
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Galaxy Health WC |
$16.18
|
| Rate for Payer: Global Benefits Group Commercial |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.42
|
| Rate for Payer: Global Benefits Group Commercial |
$15.79
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$19.74
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$19.77
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Networks By Design Commercial |
$13.18
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$22.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.37
|
| Rate for Payer: Prime Health Services Commercial |
$16.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.88
|
| Rate for Payer: United Healthcare All Other HMO |
$9.61
|
| Rate for Payer: United Healthcare All Other HMO |
$6.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9.63
|
| Rate for Payer: United Healthcare HMO Rider |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$9.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.63
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
|
OP
|
$19.03
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$17.13 |
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Adventist Health Commercial |
$5.27
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$14.47
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.47
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Central Health Plan Commercial |
$7.87
|
| Rate for Payer: Central Health Plan Commercial |
$21.06
|
| Rate for Payer: Central Health Plan Commercial |
$21.09
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: Cigna of CA HMO |
$18.42
|
| Rate for Payer: Cigna of CA HMO |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$18.42
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.54
|
| Rate for Payer: EPIC Health Plan Senior |
$10.53
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$10.54
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$22.41
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Galaxy Health WC |
$16.18
|
| Rate for Payer: Galaxy Health WC |
$22.37
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Global Benefits Group Commercial |
$15.79
|
| Rate for Payer: Global Benefits Group Commercial |
$11.42
|
| Rate for Payer: Global Benefits Group Commercial |
$15.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.02
|
| Rate for Payer: InnovAge PACE Commercial |
$13.16
|
| Rate for Payer: InnovAge PACE Commercial |
$4.92
|
| Rate for Payer: InnovAge PACE Commercial |
$13.18
|
| Rate for Payer: InnovAge PACE Commercial |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.32
|
| Rate for Payer: Multiplan Commercial |
$19.74
|
| Rate for Payer: Multiplan Commercial |
$19.77
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$13.18
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Commercial |
$22.37
|
| Rate for Payer: Prime Health Services Commercial |
$16.18
|
| Rate for Payer: Prime Health Services Commercial |
$22.41
|
| Rate for Payer: Riverside University Health System MISP |
$10.53
|
| Rate for Payer: Riverside University Health System MISP |
$10.54
|
| Rate for Payer: Riverside University Health System MISP |
$3.94
|
| Rate for Payer: Riverside University Health System MISP |
$7.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO |
$6.95
|
| Rate for Payer: United Healthcare All Other HMO |
$9.63
|
| Rate for Payer: United Healthcare All Other HMO |
$9.61
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9.41
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8.36
|
| Rate for Payer: Vantage Medical Group Senior |
$22.37
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
|
IP
|
$39.52
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Adventist Health Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California Commercial |
$30.55
|
| Rate for Payer: Blue Shield of California EPN |
$19.92
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Central Health Plan Commercial |
$31.62
|
| Rate for Payer: Cigna of CA HMO |
$27.66
|
| Rate for Payer: Cigna of CA PPO |
$27.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.81
|
| Rate for Payer: EPIC Health Plan Senior |
$15.81
|
| Rate for Payer: Galaxy Health WC |
$33.59
|
| Rate for Payer: Global Benefits Group Commercial |
$23.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$29.64
|
| Rate for Payer: Networks By Design Commercial |
$19.76
|
| Rate for Payer: Prime Health Services Commercial |
$33.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.94
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Adventist Health Commercial |
$7.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Central Health Plan Commercial |
$31.62
|
| Rate for Payer: Cigna of CA HMO |
$27.66
|
| Rate for Payer: Cigna of CA PPO |
$27.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.81
|
| Rate for Payer: EPIC Health Plan Senior |
$15.81
|
| Rate for Payer: Galaxy Health WC |
$33.59
|
| Rate for Payer: Global Benefits Group Commercial |
$23.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.02
|
| Rate for Payer: InnovAge PACE Commercial |
$19.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.66
|
| Rate for Payer: Multiplan Commercial |
$29.64
|
| Rate for Payer: Networks By Design Commercial |
$19.76
|
| Rate for Payer: Prime Health Services Commercial |
$33.59
|
| Rate for Payer: Riverside University Health System MISP |
$15.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.59
|
| Rate for Payer: Vantage Medical Group Senior |
$33.59
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
OP
|
$46.05
|
|
|
Service Code
|
NDC 0009-7663-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$41.45 |
| Rate for Payer: Adventist Health Commercial |
$9.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.05
|
| Rate for Payer: Blue Shield of California Commercial |
$28.14
|
| Rate for Payer: Blue Shield of California EPN |
$18.37
|
| Rate for Payer: Cash Price |
$25.33
|
| Rate for Payer: Central Health Plan Commercial |
$36.84
|
| Rate for Payer: Cigna of CA HMO |
$32.23
|
| Rate for Payer: Cigna of CA PPO |
$32.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.42
|
| Rate for Payer: EPIC Health Plan Senior |
$18.42
|
| Rate for Payer: Galaxy Health WC |
$39.14
|
| Rate for Payer: Global Benefits Group Commercial |
$27.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.45
|
| Rate for Payer: InnovAge PACE Commercial |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.23
|
| Rate for Payer: Multiplan Commercial |
$34.54
|
| Rate for Payer: Networks By Design Commercial |
$29.93
|
| Rate for Payer: Prime Health Services Commercial |
$39.14
|
| Rate for Payer: Riverside University Health System MISP |
$18.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.02
|
| Rate for Payer: United Healthcare All Other HMO |
$23.02
|
| Rate for Payer: United Healthcare HMO Rider |
$23.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.14
|
| Rate for Payer: Vantage Medical Group Senior |
$39.14
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
OP
|
$13.03
|
|
|
Service Code
|
NDC 0054-0080-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.73 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California EPN |
$5.20
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Central Health Plan Commercial |
$10.42
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.73
|
| Rate for Payer: InnovAge PACE Commercial |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$9.77
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Riverside University Health System MISP |
$5.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6.51
|
| Rate for Payer: United Healthcare HMO Rider |
$6.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
IP
|
$46.05
|
|
|
Service Code
|
NDC 0009-7663-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$41.45 |
| Rate for Payer: Adventist Health Commercial |
$9.21
|
| Rate for Payer: Blue Shield of California Commercial |
$35.60
|
| Rate for Payer: Blue Shield of California EPN |
$23.21
|
| Rate for Payer: Cash Price |
$25.33
|
| Rate for Payer: Central Health Plan Commercial |
$36.84
|
| Rate for Payer: Cigna of CA HMO |
$32.23
|
| Rate for Payer: Cigna of CA PPO |
$32.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.42
|
| Rate for Payer: EPIC Health Plan Senior |
$18.42
|
| Rate for Payer: Galaxy Health WC |
$39.14
|
| Rate for Payer: Global Benefits Group Commercial |
$27.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$34.54
|
| Rate for Payer: Networks By Design Commercial |
$29.93
|
| Rate for Payer: Prime Health Services Commercial |
$39.14
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
IP
|
$13.03
|
|
|
Service Code
|
NDC 0054-0080-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.73 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$10.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.57
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Central Health Plan Commercial |
$10.42
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.77
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
EZETIMIBE 10 MG TABLET [34153]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 59651-052-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: InnovAge PACE Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
EZETIMIBE 10 MG TABLET [34153]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 67877-490-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
EZETIMIBE 10 MG TABLET [34153]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 59651-052-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
EZETIMIBE 10 MG TABLET [34153]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 67877-490-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.33
|
| Rate for Payer: InnovAge PACE Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
EZETIMIBE 10 MG TABLET [34153]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 59651-052-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
EZETIMIBE 10 MG TABLET [34153]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 59651-052-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: InnovAge PACE Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
FACTOR XIII 1,000 UNIT-1,600 UNIT INTRAVENOUS SOLUTION [108721]
|
Facility
|
OP
|
$15.34
|
|
|
Service Code
|
HCPCS J7180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$28.11 |
| Rate for Payer: Adventist Health Commercial |
$3.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.63
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California EPN |
$14.89
|
| Rate for Payer: Cash Price |
$8.43
|
| Rate for Payer: Cash Price |
$8.43
|
| Rate for Payer: Central Health Plan Commercial |
$12.27
|
| Rate for Payer: Cigna of CA HMO |
$10.74
|
| Rate for Payer: Cigna of CA PPO |
$10.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.55
|
| Rate for Payer: EPIC Health Plan Senior |
$10.78
|
| Rate for Payer: Galaxy Health WC |
$13.04
|
| Rate for Payer: Global Benefits Group Commercial |
$9.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.78
|
| Rate for Payer: InnovAge PACE Commercial |
$16.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.44
|
| Rate for Payer: Multiplan Commercial |
$11.51
|
| Rate for Payer: Networks By Design Commercial |
$7.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.78
|
| Rate for Payer: Prime Health Services Commercial |
$13.04
|
| Rate for Payer: Prime Health Services Medicare |
$11.43
|
| Rate for Payer: Riverside University Health System MISP |
$11.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Other HMO |
$5.60
|
| Rate for Payer: United Healthcare HMO Rider |
$5.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.86
|
| Rate for Payer: Vantage Medical Group Senior |
$11.86
|
|
|
FACTOR XIII 1,000 UNIT-1,600 UNIT INTRAVENOUS SOLUTION [108721]
|
Facility
|
IP
|
$15.34
|
|
|
Service Code
|
HCPCS J7180
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$13.81 |
| Rate for Payer: Adventist Health Commercial |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$11.86
|
| Rate for Payer: Blue Shield of California EPN |
$7.73
|
| Rate for Payer: Cash Price |
$8.43
|
| Rate for Payer: Central Health Plan Commercial |
$12.27
|
| Rate for Payer: Cigna of CA HMO |
$10.74
|
| Rate for Payer: Cigna of CA PPO |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6.14
|
| Rate for Payer: Galaxy Health WC |
$13.04
|
| Rate for Payer: Global Benefits Group Commercial |
$9.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: Multiplan Commercial |
$11.51
|
| Rate for Payer: Networks By Design Commercial |
$7.67
|
| Rate for Payer: Prime Health Services Commercial |
$13.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Other HMO |
$5.60
|
| Rate for Payer: United Healthcare HMO Rider |
$5.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.02
|
|
|
FAMCICLOVIR 500 MG TABLET [13358]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 33342-026-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: InnovAge PACE Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
