|
FEXOFENADINE 180 MG TABLET [25425]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 41167-4120-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Senior |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
FIBRINOGEN-THROMBIN 9.5 CM X 4.8 CM TOPICAL PATCH [105430]
|
Facility
|
IP
|
$843.79
|
|
|
Service Code
|
NDC 0338-8701-00
|
| Min. Negotiated Rate |
$168.76 |
| Max. Negotiated Rate |
$759.41 |
| Rate for Payer: Adventist Health Commercial |
$168.76
|
| Rate for Payer: Cash Price |
$464.09
|
| Rate for Payer: Central Health Plan Commercial |
$675.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.52
|
| Rate for Payer: EPIC Health Plan Senior |
$337.52
|
| Rate for Payer: Galaxy Health WC |
$717.22
|
| Rate for Payer: Global Benefits Group Commercial |
$506.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.76
|
| Rate for Payer: Multiplan Commercial |
$632.84
|
| Rate for Payer: Networks By Design Commercial |
$548.46
|
| Rate for Payer: Prime Health Services Commercial |
$717.22
|
|
|
FIBRINOGEN-THROMBIN 9.5 CM X 4.8 CM TOPICAL PATCH [105430]
|
Facility
|
OP
|
$843.79
|
|
|
Service Code
|
NDC 0338-8701-00
|
| Min. Negotiated Rate |
$168.76 |
| Max. Negotiated Rate |
$759.41 |
| Rate for Payer: Adventist Health Commercial |
$168.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.56
|
| Rate for Payer: Blue Shield of California Commercial |
$515.56
|
| Rate for Payer: Blue Shield of California EPN |
$336.67
|
| Rate for Payer: Cash Price |
$464.09
|
| Rate for Payer: Central Health Plan Commercial |
$675.03
|
| Rate for Payer: Cigna of CA HMO |
$540.03
|
| Rate for Payer: Cigna of CA PPO |
$624.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.52
|
| Rate for Payer: EPIC Health Plan Senior |
$337.52
|
| Rate for Payer: Galaxy Health WC |
$717.22
|
| Rate for Payer: Global Benefits Group Commercial |
$506.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.41
|
| Rate for Payer: InnovAge PACE Commercial |
$421.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.65
|
| Rate for Payer: Multiplan Commercial |
$632.84
|
| Rate for Payer: Networks By Design Commercial |
$548.46
|
| Rate for Payer: Prime Health Services Commercial |
$717.22
|
| Rate for Payer: Riverside University Health System MISP |
$337.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.89
|
| Rate for Payer: United Healthcare All Other HMO |
$421.89
|
| Rate for Payer: United Healthcare HMO Rider |
$421.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.22
|
| Rate for Payer: Vantage Medical Group Senior |
$717.22
|
|
|
FIDAXOMICIN 200 MG TABLET [153338]
|
Facility
|
IP
|
$312.30
|
|
|
Service Code
|
NDC 52015-080-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.46 |
| Max. Negotiated Rate |
$281.07 |
| Rate for Payer: Adventist Health Commercial |
$62.46
|
| Rate for Payer: Blue Shield of California Commercial |
$241.41
|
| Rate for Payer: Blue Shield of California EPN |
$157.40
|
| Rate for Payer: Cash Price |
$171.77
|
| Rate for Payer: Central Health Plan Commercial |
$249.84
|
| Rate for Payer: Cigna of CA HMO |
$218.61
|
| Rate for Payer: Cigna of CA PPO |
$218.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.92
|
| Rate for Payer: EPIC Health Plan Senior |
$124.92
|
| Rate for Payer: Galaxy Health WC |
$265.45
|
| Rate for Payer: Global Benefits Group Commercial |
$187.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.46
|
| Rate for Payer: Multiplan Commercial |
$234.22
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.45
|
|
|
FIDAXOMICIN 200 MG TABLET [153338]
|
Facility
|
OP
|
$312.30
|
|
|
Service Code
|
NDC 52015-080-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.46 |
| Max. Negotiated Rate |
$281.07 |
| Rate for Payer: Adventist Health Commercial |
$62.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.41
|
| Rate for Payer: Blue Shield of California Commercial |
$190.82
|
| Rate for Payer: Blue Shield of California EPN |
$124.61
|
| Rate for Payer: Cash Price |
$171.77
|
| Rate for Payer: Central Health Plan Commercial |
$249.84
|
| Rate for Payer: Cigna of CA HMO |
$218.61
|
| Rate for Payer: Cigna of CA PPO |
$218.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.92
|
| Rate for Payer: EPIC Health Plan Senior |
$124.92
|
| Rate for Payer: Galaxy Health WC |
$265.45
|
| Rate for Payer: Global Benefits Group Commercial |
$187.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.07
|
| Rate for Payer: InnovAge PACE Commercial |
$156.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.61
|
| Rate for Payer: Multiplan Commercial |
$234.22
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.45
|
| Rate for Payer: Riverside University Health System MISP |
$124.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.15
|
| Rate for Payer: United Healthcare All Other HMO |
$156.15
|
| Rate for Payer: United Healthcare HMO Rider |
$156.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.45
|
| Rate for Payer: Vantage Medical Group Senior |
$265.45
|
|
|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
|
OP
|
$45.93
|
|
|
Service Code
|
NDC 52015-700-23
|
| 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 |
$26.97
|
| Rate for Payer: Blue Shield of California Commercial |
$28.06
|
| Rate for Payer: Blue Shield of California EPN |
$18.33
|
| Rate for Payer: Cash Price |
$25.26
|
| 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: 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: InnovAge PACE Commercial |
$22.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.15
|
| Rate for Payer: Molina Healthcare of CA 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 52015-700-23
|
| 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 |
$35.50
|
| Rate for Payer: Blue Shield of California EPN |
$23.15
|
| Rate for Payer: Cash Price |
$25.26
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$30.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.19
|
| Rate for Payer: Multiplan Commercial |
$34.45
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.04
|
|
|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
|
OP
|
$45.93
|
|
|
Service Code
|
NDC 52015-700-22
|
| 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 |
$26.97
|
| Rate for Payer: Blue Shield of California Commercial |
$28.06
|
| Rate for Payer: Blue Shield of California EPN |
$18.33
|
| Rate for Payer: Cash Price |
$25.26
|
| 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: 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: InnovAge PACE Commercial |
$22.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.15
|
| Rate for Payer: Molina Healthcare of CA 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 52015-700-22
|
| 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 |
$35.50
|
| Rate for Payer: Blue Shield of California EPN |
$23.15
|
| Rate for Payer: Cash Price |
$25.26
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$30.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| 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
|
OP
|
$381.60
|
|
|
Service Code
|
HCPCS Q5125
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Adventist Health Commercial |
$76.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| 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 |
$209.88
|
| Rate for Payer: Cash Price |
$209.88
|
| 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 |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| 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 |
$0.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.41
|
| Rate for Payer: InnovAge PACE Commercial |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| 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 |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$324.36
|
| Rate for Payer: Prime Health Services Medicare |
$0.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.45
|
| 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 |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
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 |
$294.98
|
| Rate for Payer: Blue Shield of California EPN |
$192.33
|
| Rate for Payer: Cash Price |
$209.88
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$254.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.21
|
| 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
|
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 |
$294.98
|
| Rate for Payer: Blue Shield of California EPN |
$192.33
|
| Rate for Payer: Cash Price |
$209.88
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$254.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.21
|
| 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 |
$0.36 |
| Max. Negotiated Rate |
$343.44 |
| Rate for Payer: Adventist Health Commercial |
$76.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| 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 |
$209.88
|
| Rate for Payer: Cash Price |
$209.88
|
| 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 |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| 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 |
$0.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.41
|
| Rate for Payer: InnovAge PACE Commercial |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| 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 |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$324.36
|
| Rate for Payer: Prime Health Services Medicare |
$0.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.45
|
| 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 |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
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 |
$0.33 |
| Max. Negotiated Rate |
$592.62 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$399.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.62
|
| 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 |
$362.16
|
| Rate for Payer: Cash Price |
$362.16
|
| 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 |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| 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 |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.37
|
| Rate for Payer: InnovAge PACE Commercial |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.49
|
| 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 |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$559.70
|
| Rate for Payer: Prime Health Services Medicare |
$0.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| 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 |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
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 |
$509.00
|
| Rate for Payer: Blue Shield of California EPN |
$331.87
|
| Rate for Payer: Cash Price |
$362.16
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.59
|
| 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
|
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 |
$509.00
|
| Rate for Payer: Blue Shield of California EPN |
$331.87
|
| Rate for Payer: Cash Price |
$362.16
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.59
|
| 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 |
$0.33 |
| Max. Negotiated Rate |
$592.62 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$399.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.62
|
| 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 |
$362.16
|
| Rate for Payer: Cash Price |
$362.16
|
| 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 |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| 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 |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.37
|
| Rate for Payer: InnovAge PACE Commercial |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.49
|
| 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 |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$559.70
|
| Rate for Payer: Prime Health Services Medicare |
$0.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| 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 |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
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 |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| 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 |
$0.38
|
| Rate for Payer: Cash Price |
$0.59
|
| 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: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$0.58
|
| 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 Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| 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 |
$0.06 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| 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 |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.38
|
| 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 |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| 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 |
$0.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.58
|
| 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 |
$0.27
|
| 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 |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.61
|
| Rate for Payer: InnovAge PACE Commercial |
$0.34
|
| Rate for Payer: InnovAge PACE Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| 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 |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| 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 |
$0.08
|
| 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 |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| 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 |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| 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: 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: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| 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 |
$0.07
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
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 |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA 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
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 86067-00047
|
| 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 |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA 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 86067-00047
|
| 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 |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.07
|
| 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: 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: InnovAge PACE Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.07
|
| 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: 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: InnovAge PACE Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
