|
ELTROMBOPAG OLAMINE 50 MG TABLET [94580]
|
Facility
IP
|
$485.71
|
|
|
Service Code
|
NDC 0078-0686-15
|
| Hospital Charge Code |
ERX94580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$97.14 |
| Max. Negotiated Rate |
$437.14 |
| Rate for Payer: Blue Shield of California Commercial |
$364.28
|
| Rate for Payer: Blue Shield of California EPN |
$259.37
|
| Rate for Payer: Cash Price |
$218.57
|
| Rate for Payer: Central Health Plan Commercial |
$388.57
|
| Rate for Payer: Cigna of CA HMO |
$340.00
|
| Rate for Payer: Cigna of CA PPO |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.28
|
| Rate for Payer: Galaxy Health WC |
$412.85
|
| Rate for Payer: Global Benefits Group Commercial |
$291.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.14
|
| Rate for Payer: Multiplan Commercial |
$364.28
|
| Rate for Payer: Networks By Design Commercial |
$315.71
|
| Rate for Payer: Prime Health Services Commercial |
$412.85
|
|
|
ELTROMBOPAG OLAMINE 50 MG TABLET [94580]
|
Facility
OP
|
$485.71
|
|
|
Service Code
|
NDC 0078-0686-15
|
| Hospital Charge Code |
ERX94580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$97.14 |
| Max. Negotiated Rate |
$437.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$294.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$412.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$267.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.96
|
| Rate for Payer: BCBS Transplant Transplant |
$291.43
|
| Rate for Payer: Blue Shield of California Commercial |
$305.51
|
| Rate for Payer: Blue Shield of California EPN |
$237.51
|
| Rate for Payer: Cash Price |
$218.57
|
| Rate for Payer: Central Health Plan Commercial |
$388.57
|
| Rate for Payer: Cigna of CA HMO |
$340.00
|
| Rate for Payer: Cigna of CA PPO |
$340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$412.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.28
|
| Rate for Payer: Galaxy Health WC |
$412.85
|
| Rate for Payer: Global Benefits Group Commercial |
$291.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$364.28
|
| Rate for Payer: IEHP medi-cal |
$170.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.14
|
| Rate for Payer: Multiplan Commercial |
$364.28
|
| Rate for Payer: Networks By Design Commercial |
$315.71
|
| Rate for Payer: Prime Health Services Commercial |
$412.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$291.43
|
| Rate for Payer: Riverside University Health MISP |
$194.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.86
|
| Rate for Payer: United Healthcare All Other HMO |
$242.86
|
| Rate for Payer: United Healthcare HMO Rider |
$242.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$242.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.85
|
| Rate for Payer: Vantage Medical Group Senior |
$412.85
|
|
|
EMAPALUMAB-LZSG 5 MG/ML INTRAVENOUS SOLUTION [223872]
|
Facility
IP
|
$2,026.21
|
|
|
Service Code
|
CPT J9210
|
| Hospital Charge Code |
NDG223872A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$405.24 |
| Max. Negotiated Rate |
$1,823.59 |
| Rate for Payer: Blue Shield of California Commercial |
$1,519.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,082.00
|
| Rate for Payer: Cash Price |
$911.79
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.97
|
| Rate for Payer: Cigna of CA HMO |
$1,418.35
|
| Rate for Payer: Cigna of CA PPO |
$1,418.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$810.48
|
| Rate for Payer: Galaxy Health WC |
$1,722.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,823.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,351.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.24
|
| Rate for Payer: Multiplan Commercial |
$1,519.66
|
| Rate for Payer: Networks By Design Commercial |
$1,013.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.28
|
|
|
EMAPALUMAB-LZSG 5 MG/ML INTRAVENOUS SOLUTION [223872]
|
Facility
OP
|
$2,026.21
|
|
|
Service Code
|
CPT J9210
|
| Hospital Charge Code |
NDG223872A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$375.66 |
| Max. Negotiated Rate |
$2,327.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$375.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,327.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$469.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$413.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$413.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$668.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.77
|
| Rate for Payer: BCBS Transplant Transplant |
$1,215.73
|
| Rate for Payer: Blue Shield of California Commercial |
$445.76
|
| Rate for Payer: Blue Shield of California EPN |
$405.24
|
| Rate for Payer: Caremore Medicare Advantage |
$375.66
|
| Rate for Payer: Cash Price |
$911.79
|
| Rate for Payer: Cash Price |
$911.79
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.97
|
| Rate for Payer: Cigna of CA HMO |
$1,418.35
|
| Rate for Payer: Cigna of CA PPO |
$1,418.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$469.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$507.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$375.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$375.66
|
| Rate for Payer: Galaxy Health WC |
$1,722.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,823.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,519.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$616.08
|
| Rate for Payer: IEHP medi-cal |
$619.83
|
| Rate for Payer: IEHP Medicare Advantage |
$375.66
|
| Rate for Payer: Innovage PACE Commercial |
$563.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,351.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$503.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$503.38
|
| Rate for Payer: Multiplan Commercial |
$1,519.66
|
| Rate for Payer: Networks By Design Commercial |
$1,013.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.28
|
| Rate for Payer: Prime Health Services Medicare |
$398.20
|
| Rate for Payer: Riverside University Health MISP |
$413.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,013.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,013.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1,013.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,013.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$469.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.22
|
| Rate for Payer: Vantage Medical Group Senior |
$413.22
|
|
|
EMOLLIENT COMBINATION NO.10 TOPICAL EMULSION [42944]
|
Facility
IP
|
$0.58
|
|
|
Service Code
|
NDC 5898096012
|
| Hospital Charge Code |
1743698
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
EMOLLIENT COMBINATION NO.10 TOPICAL EMULSION [42944]
|
Facility
IP
|
$1.33
|
|
|
Service Code
|
NDC 0187-5110-45
|
| Hospital Charge Code |
1743698
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
|
|
EMOLLIENT COMBINATION NO.10 TOPICAL EMULSION [42944]
|
Facility
OP
|
$0.58
|
|
|
Service Code
|
NDC 5898096012
|
| Hospital Charge Code |
1743698
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
EMOLLIENT COMBINATION NO.10 TOPICAL EMULSION [42944]
|
Facility
OP
|
$1.33
|
|
|
Service Code
|
NDC 0187-5110-45
|
| Hospital Charge Code |
1743698
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: BCBS Transplant Transplant |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.00
|
| Rate for Payer: IEHP medi-cal |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: Riverside University Health MISP |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
EMOLLIENT COMBINATION NO.69 TOPICAL CREAM [196535]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 7214063378
|
| Hospital Charge Code |
NDG196535A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
EMOLLIENT COMBINATION NO.69 TOPICAL CREAM [196535]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 7214063378
|
| Hospital Charge Code |
NDG196535A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
IP
|
$35.74
|
|
|
Service Code
|
NDC 98193-000-17
|
| Hospital Charge Code |
NDG4080770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Blue Shield of California Commercial |
$26.80
|
| Rate for Payer: Blue Shield of California EPN |
$19.09
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Central Health Plan Commercial |
$28.59
|
| Rate for Payer: Cigna of CA HMO |
$25.02
|
| Rate for Payer: Cigna of CA PPO |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.38
|
| Rate for Payer: Global Benefits Group Commercial |
$21.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.80
|
| Rate for Payer: Networks By Design Commercial |
$23.23
|
| Rate for Payer: Prime Health Services Commercial |
$30.38
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
IP
|
$5.11
|
|
|
Service Code
|
NDC 99408-770-02
|
| Hospital Charge Code |
1743780
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Blue Shield of California Commercial |
$3.83
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
OP
|
$35.74
|
|
|
Service Code
|
NDC 98193-000-17
|
| Hospital Charge Code |
NDG4080770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.12
|
| Rate for Payer: BCBS Transplant Transplant |
$21.44
|
| Rate for Payer: Blue Shield of California Commercial |
$22.48
|
| Rate for Payer: Blue Shield of California EPN |
$17.48
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Central Health Plan Commercial |
$28.59
|
| Rate for Payer: Cigna of CA HMO |
$25.02
|
| Rate for Payer: Cigna of CA PPO |
$25.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.38
|
| Rate for Payer: Global Benefits Group Commercial |
$21.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.80
|
| Rate for Payer: IEHP medi-cal |
$12.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.80
|
| Rate for Payer: Networks By Design Commercial |
$23.23
|
| Rate for Payer: Prime Health Services Commercial |
$30.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.44
|
| Rate for Payer: Riverside University Health MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.87
|
| Rate for Payer: United Healthcare All Other HMO |
$17.87
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.38
|
| Rate for Payer: Vantage Medical Group Senior |
$30.38
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
OP
|
$4.73
|
|
|
Service Code
|
NDC 98193-00005
|
| Hospital Charge Code |
NDG4080770B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.79
|
| Rate for Payer: BCBS Transplant Transplant |
$2.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Central Health Plan Commercial |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$3.31
|
| Rate for Payer: Cigna of CA PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$4.02
|
| Rate for Payer: Global Benefits Group Commercial |
$2.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.55
|
| Rate for Payer: IEHP medi-cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
| Rate for Payer: Networks By Design Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.84
|
| Rate for Payer: Riverside University Health MISP |
$1.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2.36
|
| Rate for Payer: United Healthcare HMO Rider |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.02
|
| Rate for Payer: Vantage Medical Group Senior |
$4.02
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
OP
|
$5.11
|
|
|
Service Code
|
NDC 99408-770-02
|
| Hospital Charge Code |
1743780
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.02
|
| Rate for Payer: BCBS Transplant Transplant |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.50
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.83
|
| Rate for Payer: IEHP medi-cal |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.83
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: Riverside University Health MISP |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
IP
|
$4.73
|
|
|
Service Code
|
NDC 98193-00005
|
| Hospital Charge Code |
NDG4080770B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Blue Shield of California Commercial |
$3.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.53
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Central Health Plan Commercial |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$3.31
|
| Rate for Payer: Cigna of CA PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$4.02
|
| Rate for Payer: Global Benefits Group Commercial |
$2.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.55
|
| Rate for Payer: Networks By Design Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.02
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
NDC 9994-0807-70
|
| Hospital Charge Code |
1743584
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
EMOLLIENTS BAG BALM OINTMENT [4080770]
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
NDC 9994-0807-70
|
| Hospital Charge Code |
1743584
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.99
|
| Rate for Payer: BCBS Transplant Transplant |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.52
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: Riverside University Health MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
IP
|
$18.54
|
|
|
Service Code
|
NDC 69097-642-02
|
| Hospital Charge Code |
1711928
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Blue Shield of California Commercial |
$13.90
|
| Rate for Payer: Blue Shield of California EPN |
$9.90
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$12.98
|
| Rate for Payer: Cigna of CA PPO |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.42
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
|
|
EMTRICITABINE 200 MG CAPSULE [36252]
|
Facility
OP
|
$18.54
|
|
|
Service Code
|
NDC 69097-642-02
|
| Hospital Charge Code |
1711928
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: BCBS Transplant Transplant |
$11.12
|
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.07
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$12.98
|
| Rate for Payer: Cigna of CA PPO |
$12.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.42
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.90
|
| Rate for Payer: IEHP medi-cal |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.12
|
| Rate for Payer: Riverside University Health MISP |
$7.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.27
|
| Rate for Payer: United Healthcare All Other HMO |
$9.27
|
| Rate for Payer: United Healthcare HMO Rider |
$9.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.76
|
| Rate for Payer: Vantage Medical Group Senior |
$15.76
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]
|
Facility
IP
|
$86.37
|
|
|
Service Code
|
NDC 61958-2002-1
|
| Hospital Charge Code |
ERX214124
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$77.73 |
| Rate for Payer: Blue Shield of California Commercial |
$64.78
|
| Rate for Payer: Blue Shield of California EPN |
$46.12
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Central Health Plan Commercial |
$69.10
|
| Rate for Payer: Cigna of CA HMO |
$60.46
|
| Rate for Payer: Cigna of CA PPO |
$60.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.55
|
| Rate for Payer: Galaxy Health WC |
$73.41
|
| Rate for Payer: Global Benefits Group Commercial |
$51.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$64.78
|
| Rate for Payer: Networks By Design Commercial |
$56.14
|
| Rate for Payer: Prime Health Services Commercial |
$73.41
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR ALAFENAMIDE FUMARATE 25 MG TABLET [214124]
|
Facility
OP
|
$86.37
|
|
|
Service Code
|
NDC 61958-2002-1
|
| Hospital Charge Code |
ERX214124
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$77.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.03
|
| Rate for Payer: BCBS Transplant Transplant |
$51.82
|
| Rate for Payer: Blue Shield of California Commercial |
$54.33
|
| Rate for Payer: Blue Shield of California EPN |
$42.23
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Central Health Plan Commercial |
$69.10
|
| Rate for Payer: Cigna of CA HMO |
$60.46
|
| Rate for Payer: Cigna of CA PPO |
$60.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.55
|
| Rate for Payer: Galaxy Health WC |
$73.41
|
| Rate for Payer: Global Benefits Group Commercial |
$51.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$64.78
|
| Rate for Payer: IEHP medi-cal |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$64.78
|
| Rate for Payer: Networks By Design Commercial |
$56.14
|
| Rate for Payer: Prime Health Services Commercial |
$73.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.82
|
| Rate for Payer: Riverside University Health MISP |
$34.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.18
|
| Rate for Payer: United Healthcare All Other HMO |
$43.18
|
| Rate for Payer: United Healthcare HMO Rider |
$43.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.41
|
| Rate for Payer: Vantage Medical Group Senior |
$73.41
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]
|
Facility
IP
|
$1.20
|
|
|
Service Code
|
CPT J0750
|
| Hospital Charge Code |
1710978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
CPT J0750
|
| Hospital Charge Code |
1710978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: BCBS Transplant Transplant |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.90
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: IEHP medi-cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.50
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Riverside University Health MISP |
$0.48
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]
|
Facility
IP
|
$6.37
|
|
|
Service Code
|
NDC 0143-9787-10
|
| Hospital Charge Code |
1721216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Blue Shield of California Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.40
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
