|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET [14825]
|
Facility
|
OP
|
$83.76
|
|
|
Service Code
|
NDC 67877-749-57
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$75.38 |
| Rate for Payer: Adventist Health Commercial |
$16.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.19
|
| Rate for Payer: Blue Shield of California Commercial |
$51.18
|
| Rate for Payer: Blue Shield of California EPN |
$33.42
|
| Rate for Payer: Cash Price |
$46.07
|
| Rate for Payer: Central Health Plan Commercial |
$67.01
|
| Rate for Payer: Cigna of CA HMO |
$58.63
|
| Rate for Payer: Cigna of CA PPO |
$58.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.50
|
| Rate for Payer: EPIC Health Plan Senior |
$33.50
|
| Rate for Payer: Galaxy Health WC |
$71.20
|
| Rate for Payer: Global Benefits Group Commercial |
$50.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.38
|
| Rate for Payer: InnovAge PACE Commercial |
$41.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.63
|
| Rate for Payer: Multiplan Commercial |
$62.82
|
| Rate for Payer: Networks By Design Commercial |
$54.44
|
| Rate for Payer: Prime Health Services Commercial |
$71.20
|
| Rate for Payer: Riverside University Health System MISP |
$33.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.88
|
| Rate for Payer: United Healthcare All Other HMO |
$41.88
|
| Rate for Payer: United Healthcare HMO Rider |
$41.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.20
|
| Rate for Payer: Vantage Medical Group Senior |
$71.20
|
|
|
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
|
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
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California Commercial |
$18.75
|
| Rate for Payer: Blue Shield of California EPN |
$12.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.65
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Central Health Plan Commercial |
$19.41
|
| Rate for Payer: Cigna of CA HMO |
$16.98
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$16.98
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$12.13
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare HMO Rider |
$8.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION [88011]
|
Facility
|
OP
|
$24.26
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Cigna of CA HMO |
$16.98
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$16.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.83
|
| Rate for Payer: InnovAge PACE Commercial |
$12.13
|
| Rate for Payer: InnovAge PACE Commercial |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.98
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$12.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: Riverside University Health System MISP |
$9.70
|
| Rate for Payer: Riverside University Health System MISP |
$1.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare HMO Rider |
$8.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$20.62
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]
|
Facility
|
OP
|
$14.55
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Central Health Plan Commercial |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$10.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.10
|
| Rate for Payer: InnovAge PACE Commercial |
$7.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.19
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$10.91
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$7.28
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
| Rate for Payer: Riverside University Health System MISP |
$5.82
|
| Rate for Payer: Riverside University Health System MISP |
$1.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO |
$5.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12.37
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION [88010]
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$7.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Central Health Plan Commercial |
$11.64
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$10.19
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO |
$5.32
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.91
|
|
|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California Commercial |
$18.75
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$7.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$12.23
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Central Health Plan Commercial |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA HMO |
$16.98
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$16.98
|
| Rate for Payer: Cigna of CA PPO |
$10.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$10.91
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$12.13
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare All Other HMO |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.77
|
|
|
FOSPHENYTOIN 50 MG PE/ML IV INJECTION SOLUTION WRAP [408056880]
|
Facility
|
OP
|
$24.26
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Central Health Plan Commercial |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$19.41
|
| Rate for Payer: Cigna of CA HMO |
$16.98
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$16.98
|
| Rate for Payer: Cigna of CA PPO |
$10.19
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: InnovAge PACE Commercial |
$12.13
|
| Rate for Payer: InnovAge PACE Commercial |
$7.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$12.13
|
| Rate for Payer: Networks By Design Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
| Rate for Payer: Riverside University Health System MISP |
$9.70
|
| Rate for Payer: Riverside University Health System MISP |
$1.31
|
| Rate for Payer: Riverside University Health System MISP |
$5.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare All Other HMO |
$5.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$12.37
|
| Rate for Payer: Vantage Medical Group Senior |
$20.62
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.97
|
| Rate for Payer: Blue Shield of California Commercial |
$21.45
|
| Rate for Payer: Blue Shield of California EPN |
$19.50
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.42
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.98
|
| Rate for Payer: InnovAge PACE Commercial |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Medicare |
$7.40
|
| Rate for Payer: Riverside University Health System MISP |
$7.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.67
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS J9394
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$109.95 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.74
|
| Rate for Payer: Blue Shield of California Commercial |
$66.00
|
| Rate for Payer: Blue Shield of California EPN |
$60.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.32
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.32
|
| Rate for Payer: InnovAge PACE Commercial |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$3.52
|
| Rate for Payer: Riverside University Health System MISP |
$3.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3.65
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS J9394
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$92.76
|
| Rate for Payer: Blue Shield of California EPN |
$60.48
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [32767]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.55
|
| Rate for Payer: Blue Shield of California EPN |
$12.10
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
|
|
FUROSEMIDE 10 MG/ML CONTINUOUS INFUSION (UNDILUTED) [4083291]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: InnovAge PACE Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
FUROSEMIDE 10 MG/ML CONTINUOUS INFUSION (UNDILUTED) [4083291]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [3291]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: InnovAge PACE Commercial |
$0.45
|
| Rate for Payer: InnovAge PACE Commercial |
$0.10
|
| Rate for Payer: InnovAge PACE Commercial |
$0.30
|
| Rate for Payer: InnovAge PACE Commercial |
$0.17
|
| Rate for Payer: InnovAge PACE Commercial |
$0.21
|
| Rate for Payer: InnovAge PACE Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.36
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION [3292]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0054-3294-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| 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 |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: InnovAge PACE Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION [3292]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0054-3294-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION [3292]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 0054-3294-50
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| 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 |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: InnovAge PACE Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION [3292]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 0054-3294-50
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
FUROSEMIDE 20 MG TABLET [3294]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 51079-072-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| 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 |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
FUROSEMIDE 20 MG TABLET [3294]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 69315-116-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
FUROSEMIDE 20 MG TABLET [3294]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 51079-072-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
FUROSEMIDE 20 MG TABLET [3294]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 69315-116-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: InnovAge PACE Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
