|
AZACITIDINE 100 MG (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
IP
|
$108.00
|
|
|
Service Code
|
CPT J9025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$162.00
|
| Rate for Payer: Blue Shield of California Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$157.50
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California EPN |
$57.67
|
| Rate for Payer: Blue Shield of California EPN |
$112.14
|
| Rate for Payer: Blue Shield of California EPN |
$115.34
|
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$151.20
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT J9025
|
| Hospital Charge Code |
1755716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$157.50
|
| Rate for Payer: Blue Shield of California EPN |
$112.14
|
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT J9025
|
| Hospital Charge Code |
1755716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.15
|
| Rate for Payer: BCBS Transplant Transplant |
$126.00
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$157.50
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health MISP |
$48.00
|
| Rate for Payer: Riverside University Health MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
OP
|
$0.81
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
NDC4081407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$218.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.61
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
OP
|
$0.66
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
ERX4081407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$218.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.61
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.26
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
IP
|
$0.81
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
ERX4081407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
IP
|
$0.81
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
NDC4081407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| 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 |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
|
|
AZATHIOPRINE 50 MG TABLET [9183]
|
Facility
IP
|
$0.41
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
1710262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
AZATHIOPRINE 50 MG TABLET [9183]
|
Facility
OP
|
$0.41
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
1710262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$218.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.31
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Riverside University Health MISP |
$0.26
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
AZATHIOPRINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080245]
|
Facility
IP
|
$0.81
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
NDG4080245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| 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 |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
|
|
AZATHIOPRINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080245]
|
Facility
OP
|
$0.81
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
NDG4080245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$218.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.61
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZELASTINE 0.05 % EYE DROPS [28351]
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
NDC 61314-308-02
|
| Hospital Charge Code |
1740346
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: BCBS Transplant Transplant |
$4.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.42
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Central Health Plan Commercial |
$5.60
|
| Rate for Payer: Cigna of CA HMO |
$4.90
|
| Rate for Payer: Cigna of CA PPO |
$4.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.25
|
| Rate for Payer: IEHP medi-cal |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$5.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.20
|
| Rate for Payer: Riverside University Health MISP |
$2.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5.95
|
|
|
AZELASTINE 0.05 % EYE DROPS [28351]
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
NDC 61314-308-02
|
| Hospital Charge Code |
1740346
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.40 |
| 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 |
$5.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Central Health Plan Commercial |
$5.60
|
| Rate for Payer: Cigna of CA HMO |
$4.90
|
| Rate for Payer: Cigna of CA PPO |
$4.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$5.95
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY AEROSOL [19179]
|
Facility
OP
|
$0.87
|
|
|
Service Code
|
NDC 47335-779-91
|
| Hospital Charge Code |
1744085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
| 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 |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.78
|
| 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 |
$0.58
|
| 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 |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: Riverside University Health MISP |
$0.35
|
| 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 |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Vantage Medical Group Senior |
$0.74
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY AEROSOL [19179]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 59651-214-30
|
| Hospital Charge Code |
1744085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| 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 |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY AEROSOL [19179]
|
Facility
OP
|
$0.87
|
|
|
Service Code
|
NDC 60505-0833-5
|
| Hospital Charge Code |
1744085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
| 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 |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.78
|
| 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 |
$0.58
|
| 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 |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: Riverside University Health MISP |
$0.35
|
| 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 |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Vantage Medical Group Senior |
$0.74
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY AEROSOL [19179]
|
Facility
IP
|
$0.87
|
|
|
Service Code
|
NDC 47335-779-91
|
| Hospital Charge Code |
1744085
|
|
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 |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| 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 |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY AEROSOL [19179]
|
Facility
IP
|
$0.87
|
|
|
Service Code
|
NDC 60505-0833-5
|
| Hospital Charge Code |
1744085
|
|
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 |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| 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 |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY AEROSOL [19179]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 59651-214-30
|
| Hospital Charge Code |
1744085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: IEHP medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Riverside University Health MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 42806-151-34
|
| Hospital Charge Code |
NDG15797A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| 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 |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]
|
Facility
IP
|
$1.06
|
|
|
Service Code
|
NDC 0069-3140-19
|
| Hospital Charge Code |
NDG15797A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| 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 |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]
|
Facility
OP
|
$1.06
|
|
|
Service Code
|
NDC 0069-3140-19
|
| Hospital Charge Code |
NDG15797A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: BCBS Transplant Transplant |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.80
|
| Rate for Payer: IEHP medi-cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: Riverside University Health MISP |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]
|
Facility
IP
|
$1.05
|
|
|
Service Code
|
NDC 0093-2026-31
|
| Hospital Charge Code |
NDG15797A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| 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 |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.89
|
| Rate for Payer: Global Benefits Group Commercial |
$0.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.89
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 42806-151-34
|
| Hospital Charge Code |
NDG15797A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [15797]
|
Facility
OP
|
$1.05
|
|
|
Service Code
|
NDC 0093-2026-31
|
| Hospital Charge Code |
NDG15797A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.62
|
| Rate for Payer: BCBS Transplant Transplant |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.89
|
| Rate for Payer: Global Benefits Group Commercial |
$0.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.79
|
| Rate for Payer: IEHP medi-cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.63
|
| Rate for Payer: Riverside University Health MISP |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Vantage Medical Group Senior |
$0.89
|
|
