|
ARTIFICIAL TEARS EYE OINTMENT [408111170]
|
Facility
IP
|
$2.34
|
|
|
Service Code
|
NDC 1011902239
|
| Hospital Charge Code |
1740053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Central Health Plan Commercial |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$1.64
|
| Rate for Payer: Cigna of CA PPO |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$1.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.52
|
| Rate for Payer: Prime Health Services Commercial |
$1.99
|
|
|
ARTIFICIAL TEARS EYE OINTMENT [408111170]
|
Facility
OP
|
$2.34
|
|
|
Service Code
|
NDC 1011902239
|
| Hospital Charge Code |
1740053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.38
|
| Rate for Payer: BCBS Transplant Transplant |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$1.05
|
| Rate for Payer: Central Health Plan Commercial |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$1.64
|
| Rate for Payer: Cigna of CA PPO |
$1.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$1.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.76
|
| Rate for Payer: IEHP medi-cal |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.52
|
| Rate for Payer: Prime Health Services Commercial |
$1.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.40
|
| Rate for Payer: Riverside University Health MISP |
$0.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1.17
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1.99
|
|
|
ARTIFICIAL TEARS EYE OINTMENT [408111170]
|
Facility
OP
|
$1.85
|
|
|
Service Code
|
NDC 0904-6488-38
|
| Hospital Charge Code |
1740053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.09
|
| Rate for Payer: BCBS Transplant Transplant |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Central Health Plan Commercial |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.39
|
| Rate for Payer: IEHP medi-cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.11
|
| Rate for Payer: Riverside University Health MISP |
$0.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.57
|
|
|
ARTIFICIAL TEARS EYE OINTMENT [408111170]
|
Facility
IP
|
$1.85
|
|
|
Service Code
|
NDC 0904-6488-38
|
| Hospital Charge Code |
1740053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Central Health Plan Commercial |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
|
|
ARTIFICIAL TEARS EYE OINTMENT [408111170]
|
Facility
OP
|
$3.35
|
|
|
Service Code
|
NDC 0023-0312-04
|
| Hospital Charge Code |
1740053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.98
|
| Rate for Payer: BCBS Transplant Transplant |
$2.01
|
| 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 |
$2.68
|
| Rate for Payer: Cigna of CA HMO |
$2.34
|
| Rate for Payer: Cigna of CA PPO |
$2.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.51
|
| Rate for Payer: IEHP medi-cal |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.01
|
| Rate for Payer: Riverside University Health MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.01
|
| 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 |
$2.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2.85
|
|
|
ARTIFICIAL TEARS EYE OINTMENT [408111170]
|
Facility
IP
|
$3.35
|
|
|
Service Code
|
NDC 0023-0312-04
|
| Hospital Charge Code |
1740053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.68
|
| Rate for Payer: Cigna of CA HMO |
$2.34
|
| Rate for Payer: Cigna of CA PPO |
$2.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.85
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL [21058]
|
Facility
IP
|
$0.86
|
|
|
Service Code
|
NDC 0065-8064-01
|
| Hospital Charge Code |
1740326
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.73
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.3 % EYE GEL [21058]
|
Facility
OP
|
$0.86
|
|
|
Service Code
|
NDC 0065-8064-01
|
| Hospital Charge Code |
1740326
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.51
|
| Rate for Payer: BCBS Transplant Transplant |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.65
|
| Rate for Payer: IEHP medi-cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.73
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: Riverside University Health MISP |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.73
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS [27980]
|
Facility
OP
|
$2.27
|
|
|
Service Code
|
NDC 0998-0408-15
|
| Hospital Charge Code |
1740176
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.34
|
| Rate for Payer: BCBS Transplant Transplant |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.82
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.70
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: Riverside University Health MISP |
$0.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.93
|
|
|
ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS [27980]
|
Facility
IP
|
$2.27
|
|
|
Service Code
|
NDC 0998-0408-15
|
| Hospital Charge Code |
1740176
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.82
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
|
|
Arytenoidectomy or arytenoidopexy, external approach
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 31400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
ASCIMINIB 20 MG TABLET [233024]
|
Facility
OP
|
$402.11
|
|
|
Service Code
|
NDC 0078-1091-20
|
| Hospital Charge Code |
ERX233024
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.42 |
| Max. Negotiated Rate |
$361.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$244.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$341.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$221.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$221.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.57
|
| Rate for Payer: BCBS Transplant Transplant |
$241.27
|
| Rate for Payer: Blue Shield of California Commercial |
$252.93
|
| Rate for Payer: Blue Shield of California EPN |
$196.63
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Central Health Plan Commercial |
$321.69
|
| Rate for Payer: Cigna of CA HMO |
$281.48
|
| Rate for Payer: Cigna of CA PPO |
$281.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$341.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$160.84
|
| Rate for Payer: Galaxy Health WC |
$341.79
|
| Rate for Payer: Global Benefits Group Commercial |
$241.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$301.58
|
| Rate for Payer: IEHP medi-cal |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.42
|
| Rate for Payer: Multiplan Commercial |
$301.58
|
| Rate for Payer: Networks By Design Commercial |
$261.37
|
| Rate for Payer: Prime Health Services Commercial |
$341.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$241.27
|
| Rate for Payer: Riverside University Health MISP |
$160.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.06
|
| Rate for Payer: United Healthcare All Other HMO |
$201.06
|
| Rate for Payer: United Healthcare HMO Rider |
$201.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.79
|
| Rate for Payer: Vantage Medical Group Senior |
$341.79
|
|
|
ASCIMINIB 20 MG TABLET [233024]
|
Facility
IP
|
$402.11
|
|
|
Service Code
|
NDC 0078-1091-20
|
| Hospital Charge Code |
ERX233024
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.42 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$301.58
|
| Rate for Payer: Blue Shield of California EPN |
$214.73
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Central Health Plan Commercial |
$321.69
|
| Rate for Payer: Cigna of CA HMO |
$281.48
|
| Rate for Payer: Cigna of CA PPO |
$281.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.84
|
| Rate for Payer: Galaxy Health WC |
$341.79
|
| Rate for Payer: Global Benefits Group Commercial |
$241.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.42
|
| Rate for Payer: Multiplan Commercial |
$301.58
|
| Rate for Payer: Networks By Design Commercial |
$261.37
|
| Rate for Payer: Prime Health Services Commercial |
$341.79
|
|
|
ASCIMINIB 40 MG TABLET [233025]
|
Facility
OP
|
$402.11
|
|
|
Service Code
|
NDC 0078-1098-20
|
| Hospital Charge Code |
ERX233025
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.42 |
| Max. Negotiated Rate |
$361.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$244.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$341.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$221.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$221.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.57
|
| Rate for Payer: BCBS Transplant Transplant |
$241.27
|
| Rate for Payer: Blue Shield of California Commercial |
$252.93
|
| Rate for Payer: Blue Shield of California EPN |
$196.63
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Central Health Plan Commercial |
$321.69
|
| Rate for Payer: Cigna of CA HMO |
$281.48
|
| Rate for Payer: Cigna of CA PPO |
$281.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$341.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$160.84
|
| Rate for Payer: Galaxy Health WC |
$341.79
|
| Rate for Payer: Global Benefits Group Commercial |
$241.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$301.58
|
| Rate for Payer: IEHP medi-cal |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.42
|
| Rate for Payer: Multiplan Commercial |
$301.58
|
| Rate for Payer: Networks By Design Commercial |
$261.37
|
| Rate for Payer: Prime Health Services Commercial |
$341.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$241.27
|
| Rate for Payer: Riverside University Health MISP |
$160.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.06
|
| Rate for Payer: United Healthcare All Other HMO |
$201.06
|
| Rate for Payer: United Healthcare HMO Rider |
$201.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.79
|
| Rate for Payer: Vantage Medical Group Senior |
$341.79
|
|
|
ASCIMINIB 40 MG TABLET [233025]
|
Facility
IP
|
$402.11
|
|
|
Service Code
|
NDC 0078-1098-20
|
| Hospital Charge Code |
ERX233025
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.42 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$301.58
|
| Rate for Payer: Blue Shield of California EPN |
$214.73
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Central Health Plan Commercial |
$321.69
|
| Rate for Payer: Cigna of CA HMO |
$281.48
|
| Rate for Payer: Cigna of CA PPO |
$281.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.84
|
| Rate for Payer: Galaxy Health WC |
$341.79
|
| Rate for Payer: Global Benefits Group Commercial |
$241.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.42
|
| Rate for Payer: Multiplan Commercial |
$301.58
|
| Rate for Payer: Networks By Design Commercial |
$261.37
|
| Rate for Payer: Prime Health Services Commercial |
$341.79
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL LIQUID [227420]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 6961801854
|
| Hospital Charge Code |
NDG216878
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| 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: 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: 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
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL LIQUID [227420]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 6961801854
|
| Hospital Charge Code |
NDG216878
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| 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: BCBS Transplant Transplant |
$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 |
$0.02
|
| 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: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP [115152]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 5789684216
|
| Hospital Charge Code |
1719087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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: 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
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP [115152]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 5789684216
|
| Hospital Charge Code |
1719087
|
|
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
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION [654]
|
Facility
OP
|
$2.17
|
|
|
Service Code
|
NDC 67457-118-50
|
| Hospital Charge Code |
1757957
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.28
|
| Rate for Payer: BCBS Transplant Transplant |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.63
|
| Rate for Payer: IEHP medi-cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Networks By Design Commercial |
$1.41
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Riverside University Health MISP |
$0.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INJECTION SOLUTION [654]
|
Facility
IP
|
$2.17
|
|
|
Service Code
|
NDC 67457-118-50
|
| Hospital Charge Code |
1757957
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Central Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.63
|
| Rate for Payer: Networks By Design Commercial |
$1.41
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION [221033]
|
Facility
OP
|
$6.49
|
|
|
Service Code
|
NDC 67157-101-50
|
| Hospital Charge Code |
1757957
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.83
|
| Rate for Payer: BCBS Transplant Transplant |
$3.89
|
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Central Health Plan Commercial |
$5.19
|
| Rate for Payer: Cigna of CA HMO |
$4.15
|
| Rate for Payer: Cigna of CA PPO |
$4.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.60
|
| Rate for Payer: Galaxy Health WC |
$5.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.87
|
| Rate for Payer: IEHP medi-cal |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.87
|
| Rate for Payer: Networks By Design Commercial |
$4.22
|
| Rate for Payer: Prime Health Services Commercial |
$5.52
|
| Rate for Payer: Riverside University Health MISP |
$2.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.52
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION [221033]
|
Facility
OP
|
$6.42
|
|
|
Service Code
|
NDC 67157-101-51
|
| Hospital Charge Code |
1757957
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.79
|
| Rate for Payer: BCBS Transplant Transplant |
$3.85
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Central Health Plan Commercial |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$4.11
|
| Rate for Payer: Cigna of CA PPO |
$4.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.57
|
| Rate for Payer: Galaxy Health WC |
$5.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.82
|
| Rate for Payer: IEHP medi-cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$4.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.46
|
| Rate for Payer: Riverside University Health MISP |
$2.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.21
|
| Rate for Payer: United Healthcare All Other HMO |
$3.21
|
| Rate for Payer: United Healthcare HMO Rider |
$3.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.46
|
| Rate for Payer: Vantage Medical Group Senior |
$5.46
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION [221033]
|
Facility
IP
|
$6.49
|
|
|
Service Code
|
NDC 67157-101-50
|
| Hospital Charge Code |
1757957
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.47
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Central Health Plan Commercial |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.60
|
| Rate for Payer: Galaxy Health WC |
$5.52
|
| Rate for Payer: Global Benefits Group Commercial |
$3.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.87
|
| Rate for Payer: Networks By Design Commercial |
$4.22
|
| Rate for Payer: Prime Health Services Commercial |
$5.52
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION [221033]
|
Facility
IP
|
$6.42
|
|
|
Service Code
|
NDC 67157-101-51
|
| Hospital Charge Code |
1757957
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$3.43
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Central Health Plan Commercial |
$5.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: Galaxy Health WC |
$5.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$4.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.46
|
|
