|
FOLIC ACID ORAL SOLUTION COMPOUND 1 MG/ML [4080276]
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 9994-0802-76
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
FOLIC ACID ORAL SOLUTION COMPOUND 1 MG/ML [4080276]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 9994-0802-76
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: InnovAge PACE Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Blue Shield of California Commercial |
$609.12
|
| Rate for Payer: Blue Shield of California EPN |
$397.15
|
| Rate for Payer: Cash Price |
$433.40
|
| Rate for Payer: Central Health Plan Commercial |
$630.40
|
| Rate for Payer: Cigna of CA HMO |
$551.60
|
| Rate for Payer: Cigna of CA PPO |
$551.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.20
|
| Rate for Payer: EPIC Health Plan Senior |
$315.20
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$709.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$525.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$487.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.60
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
| Rate for Payer: Networks By Design Commercial |
$394.00
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare HMO Rider |
$281.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.07
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION [22185]
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$478.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.53
|
| Rate for Payer: Blue Shield of California Commercial |
$16.68
|
| Rate for Payer: Blue Shield of California EPN |
$15.16
|
| Rate for Payer: Cash Price |
$433.40
|
| Rate for Payer: Cash Price |
$433.40
|
| Rate for Payer: Central Health Plan Commercial |
$630.40
|
| Rate for Payer: Cigna of CA HMO |
$551.60
|
| Rate for Payer: Cigna of CA PPO |
$551.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6.03
|
| Rate for Payer: Galaxy Health WC |
$669.80
|
| Rate for Payer: Global Benefits Group Commercial |
$472.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$709.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: InnovAge PACE Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$525.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.07
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
| Rate for Payer: Networks By Design Commercial |
$394.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$669.80
|
| Rate for Payer: Prime Health Services Medicare |
$6.39
|
| Rate for Payer: Riverside University Health System MISP |
$6.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.74
|
| Rate for Payer: United Healthcare All Other HMO |
$287.86
|
| Rate for Payer: United Healthcare HMO Rider |
$281.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE [108029]
|
Facility
|
IP
|
$87.15
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$78.44 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Blue Shield of California Commercial |
$67.37
|
| Rate for Payer: Blue Shield of California EPN |
$43.92
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Central Health Plan Commercial |
$69.72
|
| Rate for Payer: Cigna of CA HMO |
$61.01
|
| Rate for Payer: Cigna of CA PPO |
$61.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.86
|
| Rate for Payer: EPIC Health Plan Senior |
$34.86
|
| Rate for Payer: Galaxy Health WC |
$74.08
|
| Rate for Payer: Global Benefits Group Commercial |
$52.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$65.36
|
| Rate for Payer: Networks By Design Commercial |
$43.58
|
| Rate for Payer: Prime Health Services Commercial |
$74.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.71
|
| Rate for Payer: United Healthcare All Other HMO |
$31.84
|
| Rate for Payer: United Healthcare HMO Rider |
$31.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.54
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE [108029]
|
Facility
|
OP
|
$87.15
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$78.44 |
| Rate for Payer: Adventist Health Commercial |
$17.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Central Health Plan Commercial |
$69.72
|
| Rate for Payer: Cigna of CA HMO |
$61.01
|
| Rate for Payer: Cigna of CA PPO |
$61.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.86
|
| Rate for Payer: EPIC Health Plan Senior |
$34.86
|
| Rate for Payer: Galaxy Health WC |
$74.08
|
| Rate for Payer: Global Benefits Group Commercial |
$52.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.86
|
| Rate for Payer: InnovAge PACE Commercial |
$43.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.01
|
| Rate for Payer: Multiplan Commercial |
$65.36
|
| Rate for Payer: Networks By Design Commercial |
$43.58
|
| Rate for Payer: Prime Health Services Commercial |
$74.08
|
| Rate for Payer: Riverside University Health System MISP |
$34.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.71
|
| Rate for Payer: United Healthcare All Other HMO |
$31.84
|
| Rate for Payer: United Healthcare HMO Rider |
$31.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.08
|
| Rate for Payer: Vantage Medical Group Senior |
$74.08
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
OP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$53.69 |
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$32.81
|
| Rate for Payer: Cash Price |
$32.81
|
| Rate for Payer: Central Health Plan Commercial |
$47.73
|
| Rate for Payer: Cigna of CA HMO |
$41.76
|
| Rate for Payer: Cigna of CA PPO |
$41.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.86
|
| Rate for Payer: EPIC Health Plan Senior |
$23.86
|
| Rate for Payer: Galaxy Health WC |
$50.71
|
| Rate for Payer: Global Benefits Group Commercial |
$35.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.86
|
| Rate for Payer: InnovAge PACE Commercial |
$29.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$44.74
|
| Rate for Payer: Networks By Design Commercial |
$29.83
|
| Rate for Payer: Prime Health Services Commercial |
$50.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$21.79
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.71
|
| Rate for Payer: Vantage Medical Group Senior |
$50.71
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE [32215]
|
Facility
|
IP
|
$59.66
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$53.69 |
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Blue Shield of California Commercial |
$46.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.07
|
| Rate for Payer: Cash Price |
$32.81
|
| Rate for Payer: Central Health Plan Commercial |
$47.73
|
| Rate for Payer: Cigna of CA HMO |
$41.76
|
| Rate for Payer: Cigna of CA PPO |
$41.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.86
|
| Rate for Payer: EPIC Health Plan Senior |
$23.86
|
| Rate for Payer: Galaxy Health WC |
$50.71
|
| Rate for Payer: Global Benefits Group Commercial |
$35.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$44.74
|
| Rate for Payer: Networks By Design Commercial |
$29.83
|
| Rate for Payer: Prime Health Services Commercial |
$50.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.39
|
| Rate for Payer: United Healthcare All Other HMO |
$21.79
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.54
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
IP
|
$110.60
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Blue Shield of California Commercial |
$85.49
|
| Rate for Payer: Blue Shield of California Commercial |
$83.98
|
| Rate for Payer: Blue Shield of California EPN |
$54.75
|
| Rate for Payer: Blue Shield of California EPN |
$55.74
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Central Health Plan Commercial |
$88.48
|
| Rate for Payer: Central Health Plan Commercial |
$86.91
|
| Rate for Payer: Cigna of CA HMO |
$76.05
|
| Rate for Payer: Cigna of CA HMO |
$77.42
|
| Rate for Payer: Cigna of CA PPO |
$76.05
|
| Rate for Payer: Cigna of CA PPO |
$77.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.24
|
| Rate for Payer: EPIC Health Plan Senior |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$44.24
|
| Rate for Payer: Galaxy Health WC |
$92.34
|
| Rate for Payer: Galaxy Health WC |
$94.01
|
| Rate for Payer: Global Benefits Group Commercial |
$66.36
|
| Rate for Payer: Global Benefits Group Commercial |
$65.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.73
|
| Rate for Payer: Multiplan Commercial |
$81.48
|
| Rate for Payer: Multiplan Commercial |
$82.95
|
| Rate for Payer: Networks By Design Commercial |
$54.32
|
| Rate for Payer: Networks By Design Commercial |
$55.30
|
| Rate for Payer: Prime Health Services Commercial |
$94.01
|
| Rate for Payer: Prime Health Services Commercial |
$92.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.51
|
| Rate for Payer: United Healthcare All Other HMO |
$40.40
|
| Rate for Payer: United Healthcare All Other HMO |
$39.69
|
| Rate for Payer: United Healthcare HMO Rider |
$38.83
|
| Rate for Payer: United Healthcare HMO Rider |
$39.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.22
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE [108028]
|
Facility
|
OP
|
$110.60
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Adventist Health Commercial |
$21.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Central Health Plan Commercial |
$88.48
|
| Rate for Payer: Central Health Plan Commercial |
$86.91
|
| Rate for Payer: Cigna of CA HMO |
$76.05
|
| Rate for Payer: Cigna of CA HMO |
$77.42
|
| Rate for Payer: Cigna of CA PPO |
$77.42
|
| Rate for Payer: Cigna of CA PPO |
$76.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$43.46
|
| Rate for Payer: EPIC Health Plan Senior |
$44.24
|
| Rate for Payer: Galaxy Health WC |
$94.01
|
| Rate for Payer: Galaxy Health WC |
$92.34
|
| Rate for Payer: Global Benefits Group Commercial |
$66.36
|
| Rate for Payer: Global Benefits Group Commercial |
$65.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.86
|
| Rate for Payer: InnovAge PACE Commercial |
$54.32
|
| Rate for Payer: InnovAge PACE Commercial |
$55.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.42
|
| Rate for Payer: Multiplan Commercial |
$81.48
|
| Rate for Payer: Multiplan Commercial |
$82.95
|
| Rate for Payer: Networks By Design Commercial |
$54.32
|
| Rate for Payer: Networks By Design Commercial |
$55.30
|
| Rate for Payer: Prime Health Services Commercial |
$94.01
|
| Rate for Payer: Prime Health Services Commercial |
$92.34
|
| Rate for Payer: Riverside University Health System MISP |
$43.46
|
| Rate for Payer: Riverside University Health System MISP |
$44.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.77
|
| Rate for Payer: United Healthcare All Other HMO |
$40.40
|
| Rate for Payer: United Healthcare All Other HMO |
$39.69
|
| Rate for Payer: United Healthcare HMO Rider |
$38.83
|
| Rate for Payer: United Healthcare HMO Rider |
$39.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.01
|
| Rate for Payer: Vantage Medical Group Senior |
$94.01
|
| Rate for Payer: Vantage Medical Group Senior |
$92.34
|
|
|
FOOD SUPPLEMNT,LACTO-REDUCE 0.05 GRAM-1.2 KCAL/ML LIQUID FOR TUBE FEED [216461]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 4390018480
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
FOOD SUPPLEMNT,LACTO-REDUCE 0.05 GRAM-1.2 KCAL/ML LIQUID FOR TUBE FEED [216461]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 4390018480
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.20
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.20
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-95
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.91
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: InnovAge PACE Commercial |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Riverside University Health System MISP |
$4.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION [88225]
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 49502-605-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.91
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: InnovAge PACE Commercial |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Riverside University Health System MISP |
$4.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Commercial |
$19.72
|
| Rate for Payer: Blue Shield of California Commercial |
$25.97
|
| Rate for Payer: Blue Shield of California Commercial |
$76.23
|
| Rate for Payer: Blue Shield of California Commercial |
$38.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.19
|
| Rate for Payer: Blue Shield of California Commercial |
$37.10
|
| Rate for Payer: Blue Shield of California EPN |
$25.40
|
| Rate for Payer: Blue Shield of California EPN |
$16.93
|
| Rate for Payer: Blue Shield of California EPN |
$49.70
|
| Rate for Payer: Blue Shield of California EPN |
$24.19
|
| Rate for Payer: Blue Shield of California EPN |
$15.12
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$78.90
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Central Health Plan Commercial |
$40.32
|
| Rate for Payer: Cigna of CA HMO |
$69.03
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$69.03
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$39.45
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$83.83
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Global Benefits Group Commercial |
$59.17
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$73.97
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$49.31
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Prime Health Services Commercial |
$83.83
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare All Other HMO |
$36.03
|
| Rate for Payer: United Healthcare HMO Rider |
$35.25
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare HMO Rider |
$17.16
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION [106783]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$19.72
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cash Price |
$54.24
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$40.32
|
| Rate for Payer: Central Health Plan Commercial |
$78.90
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$69.03
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$69.03
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$33.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.45
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$39.45
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$83.83
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$59.17
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.12
|
| Rate for Payer: InnovAge PACE Commercial |
$24.00
|
| Rate for Payer: InnovAge PACE Commercial |
$25.20
|
| Rate for Payer: InnovAge PACE Commercial |
$16.80
|
| Rate for Payer: InnovAge PACE Commercial |
$49.31
|
| Rate for Payer: InnovAge PACE Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.03
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$73.97
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$49.31
|
| Rate for Payer: Networks By Design Commercial |
$24.00
|
| Rate for Payer: Prime Health Services Commercial |
$83.83
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Riverside University Health System MISP |
$13.44
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Riverside University Health System MISP |
$20.16
|
| Rate for Payer: Riverside University Health System MISP |
$39.45
|
| Rate for Payer: Riverside University Health System MISP |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.01
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.27
|
| Rate for Payer: United Healthcare All Other HMO |
$36.03
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.53
|
| Rate for Payer: United Healthcare HMO Rider |
$17.16
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare HMO Rider |
$35.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$83.83
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION [10093]
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Central Health Plan Commercial |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Central Health Plan Commercial |
$1.82
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION [10093]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$143.94 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.18
|
| Rate for Payer: Blue Shield of California Commercial |
$86.41
|
| Rate for Payer: Blue Shield of California Commercial |
$86.41
|
| Rate for Payer: Blue Shield of California Commercial |
$86.41
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Central Health Plan Commercial |
$1.82
|
| Rate for Payer: Cigna of CA HMO |
$1.43
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.43
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.04
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: InnovAge PACE Commercial |
$23.38
|
| Rate for Payer: InnovAge PACE Commercial |
$23.38
|
| Rate for Payer: InnovAge PACE Commercial |
$23.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.58
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Medicare |
$16.52
|
| Rate for Payer: Prime Health Services Medicare |
$16.52
|
| Rate for Payer: Prime Health Services Medicare |
$16.52
|
| Rate for Payer: Riverside University Health System MISP |
$17.14
|
| Rate for Payer: Riverside University Health System MISP |
$17.14
|
| Rate for Payer: Riverside University Health System MISP |
$17.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
|
|
FOSCARNET INTRAVITREAL INJECTION 2400 MCG/0.1 ML [4081568]
|
Facility
|
OP
|
$2.30
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$143.94 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.18
|
| Rate for Payer: Blue Shield of California Commercial |
$86.41
|
| Rate for Payer: Blue Shield of California EPN |
$78.55
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Central Health Plan Commercial |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$1.61
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.04
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.58
|
| Rate for Payer: InnovAge PACE Commercial |
$23.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$1.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.58
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Medicare |
$16.52
|
| Rate for Payer: Riverside University Health System MISP |
$17.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Vantage Medical Group Senior |
$17.14
|
|
|
FOSCARNET INTRAVITREAL INJECTION 2400 MCG/0.1 ML [4081568]
|
Facility
|
IP
|
$2.30
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Central Health Plan Commercial |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$1.61
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$1.15
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$86.74 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Blue Shield of California Commercial |
$74.50
|
| Rate for Payer: Blue Shield of California EPN |
$48.58
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Central Health Plan Commercial |
$77.10
|
| Rate for Payer: Cigna of CA HMO |
$67.47
|
| Rate for Payer: Cigna of CA PPO |
$67.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.55
|
| Rate for Payer: EPIC Health Plan Senior |
$38.55
|
| Rate for Payer: Galaxy Health WC |
$81.92
|
| Rate for Payer: Global Benefits Group Commercial |
$57.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$72.28
|
| Rate for Payer: Networks By Design Commercial |
$62.65
|
| Rate for Payer: Prime Health Services Commercial |
$81.92
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
IP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-94
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$86.74 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Blue Shield of California Commercial |
$74.50
|
| Rate for Payer: Blue Shield of California EPN |
$48.58
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Central Health Plan Commercial |
$77.10
|
| Rate for Payer: Cigna of CA HMO |
$67.47
|
| Rate for Payer: Cigna of CA PPO |
$67.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.55
|
| Rate for Payer: EPIC Health Plan Senior |
$38.55
|
| Rate for Payer: Galaxy Health WC |
$81.92
|
| Rate for Payer: Global Benefits Group Commercial |
$57.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$72.28
|
| Rate for Payer: Networks By Design Commercial |
$62.65
|
| Rate for Payer: Prime Health Services Commercial |
$81.92
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$96.38
|
|
|
Service Code
|
NDC 70700-268-99
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$86.74 |
| Rate for Payer: Adventist Health Commercial |
$19.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.60
|
| Rate for Payer: Blue Shield of California Commercial |
$58.89
|
| Rate for Payer: Blue Shield of California EPN |
$38.46
|
| Rate for Payer: Cash Price |
$53.01
|
| Rate for Payer: Central Health Plan Commercial |
$77.10
|
| Rate for Payer: Cigna of CA HMO |
$67.47
|
| Rate for Payer: Cigna of CA PPO |
$67.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.55
|
| Rate for Payer: EPIC Health Plan Senior |
$38.55
|
| Rate for Payer: Galaxy Health WC |
$81.92
|
| Rate for Payer: Global Benefits Group Commercial |
$57.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.74
|
| Rate for Payer: InnovAge PACE Commercial |
$48.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$72.28
|
| Rate for Payer: Networks By Design Commercial |
$62.65
|
| Rate for Payer: Prime Health Services Commercial |
$81.92
|
| Rate for Payer: Riverside University Health System MISP |
$38.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.19
|
| Rate for Payer: United Healthcare All Other HMO |
$48.19
|
| Rate for Payer: United Healthcare HMO Rider |
$48.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.92
|
| Rate for Payer: Vantage Medical Group Senior |
$81.92
|
|
