|
BARICITINIB 1 MG TABLET [225594]
|
Facility
OP
|
$104.88
|
|
|
Service Code
|
NDC 0002-4732-30
|
| Hospital Charge Code |
ERX225594
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$94.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$57.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.96
|
| Rate for Payer: BCBS Transplant Transplant |
$62.93
|
| Rate for Payer: Blue Shield of California Commercial |
$65.97
|
| Rate for Payer: Blue Shield of California EPN |
$51.29
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Central Health Plan Commercial |
$83.90
|
| Rate for Payer: Cigna of CA HMO |
$73.42
|
| Rate for Payer: Cigna of CA PPO |
$73.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.95
|
| Rate for Payer: Galaxy Health WC |
$89.15
|
| Rate for Payer: Global Benefits Group Commercial |
$62.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$78.66
|
| Rate for Payer: IEHP medi-cal |
$36.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.98
|
| Rate for Payer: Multiplan Commercial |
$78.66
|
| Rate for Payer: Networks By Design Commercial |
$68.17
|
| Rate for Payer: Prime Health Services Commercial |
$89.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$62.93
|
| Rate for Payer: Riverside University Health MISP |
$41.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.44
|
| Rate for Payer: United Healthcare All Other HMO |
$52.44
|
| Rate for Payer: United Healthcare HMO Rider |
$52.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.15
|
| Rate for Payer: Vantage Medical Group Senior |
$89.15
|
|
|
BARICITINIB 1 MG TABLET [225594]
|
Facility
IP
|
$104.88
|
|
|
Service Code
|
NDC 0002-4732-30
|
| Hospital Charge Code |
ERX225594
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$94.39 |
| Rate for Payer: Blue Shield of California Commercial |
$78.66
|
| Rate for Payer: Blue Shield of California EPN |
$56.01
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Central Health Plan Commercial |
$83.90
|
| Rate for Payer: Cigna of CA HMO |
$73.42
|
| Rate for Payer: Cigna of CA PPO |
$73.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.95
|
| Rate for Payer: Galaxy Health WC |
$89.15
|
| Rate for Payer: Global Benefits Group Commercial |
$62.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.98
|
| Rate for Payer: Multiplan Commercial |
$78.66
|
| Rate for Payer: Networks By Design Commercial |
$68.17
|
| Rate for Payer: Prime Health Services Commercial |
$89.15
|
|
|
BARICITINIB 2 MG TABLET [221907]
|
Facility
IP
|
$104.88
|
|
|
Service Code
|
CPT J8499
|
| Hospital Charge Code |
ERX221907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$94.39 |
| Rate for Payer: Blue Shield of California Commercial |
$78.66
|
| Rate for Payer: Blue Shield of California EPN |
$56.01
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Central Health Plan Commercial |
$83.90
|
| Rate for Payer: Cigna of CA HMO |
$73.42
|
| Rate for Payer: Cigna of CA PPO |
$73.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.95
|
| Rate for Payer: Galaxy Health WC |
$89.15
|
| Rate for Payer: Global Benefits Group Commercial |
$62.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.98
|
| Rate for Payer: Multiplan Commercial |
$78.66
|
| Rate for Payer: Networks By Design Commercial |
$52.44
|
| Rate for Payer: Prime Health Services Commercial |
$89.15
|
|
|
BARICITINIB 2 MG TABLET [221907]
|
Facility
OP
|
$104.88
|
|
|
Service Code
|
CPT J8499
|
| Hospital Charge Code |
ERX221907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$94.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$57.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.68
|
| Rate for Payer: BCBS Transplant Transplant |
$62.93
|
| Rate for Payer: Blue Shield of California Commercial |
$65.97
|
| Rate for Payer: Blue Shield of California EPN |
$51.29
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Central Health Plan Commercial |
$83.90
|
| Rate for Payer: Cigna of CA HMO |
$73.42
|
| Rate for Payer: Cigna of CA PPO |
$73.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.95
|
| Rate for Payer: Galaxy Health WC |
$89.15
|
| Rate for Payer: Global Benefits Group Commercial |
$62.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$78.66
|
| Rate for Payer: IEHP medi-cal |
$36.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.98
|
| Rate for Payer: Multiplan Commercial |
$78.66
|
| Rate for Payer: Networks By Design Commercial |
$52.44
|
| Rate for Payer: Prime Health Services Commercial |
$89.15
|
| Rate for Payer: Riverside University Health MISP |
$41.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.44
|
| Rate for Payer: United Healthcare All Other HMO |
$52.44
|
| Rate for Payer: United Healthcare HMO Rider |
$52.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.15
|
| Rate for Payer: Vantage Medical Group Senior |
$89.15
|
|
|
BARIUM SULFATE 105 % (W/V), 58 % (W/W) ORAL SUSPENSION [97296]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 32909-167-55
|
| Hospital Charge Code |
NDG972961
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
BARIUM SULFATE 105 % (W/V), 58 % (W/W) ORAL SUSPENSION [97296]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 32909-167-55
|
| Hospital Charge Code |
NDG972961
|
|
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
|
|
|
BARIUM SULFATE 40 % (W/V), 29 % (W/W) (1,500 CPS) ORAL SUSPENSION [223877]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 32909-121-07
|
| Hospital Charge Code |
NDG120621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
BARIUM SULFATE 40 % (W/V), 29 % (W/W) (1,500 CPS) ORAL SUSPENSION [223877]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 32909-121-07
|
| Hospital Charge Code |
NDG120621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 32909-750-01
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 32909-750-01
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 32909-750-03
|
| Hospital Charge Code |
NDG13031
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 32909-750-03
|
| Hospital Charge Code |
NDG13031
|
|
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
|
|
|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 32909-750-01
|
| Hospital Charge Code |
NDG13031
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
BARIUM SULFATE 96 % (W/W) ORAL POWDER FOR SUSPENSION [13031]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 32909-750-01
|
| Hospital Charge Code |
NDG13031
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
BARRIER FILM CAVILON SPRAY
|
Facility
OP
|
$50.76
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.99
|
| Rate for Payer: BCBS Transplant Transplant |
$30.46
|
| Rate for Payer: Blue Shield of California Commercial |
$31.93
|
| Rate for Payer: Blue Shield of California EPN |
$24.82
|
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: Cigna of CA HMO |
$32.49
|
| Rate for Payer: Cigna of CA PPO |
$37.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.07
|
| Rate for Payer: IEHP medi-cal |
$17.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.46
|
| Rate for Payer: Riverside University Health MISP |
$20.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.38
|
| Rate for Payer: United Healthcare All Other HMO |
$25.38
|
| Rate for Payer: United Healthcare HMO Rider |
$25.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.15
|
| Rate for Payer: Vantage Medical Group Senior |
$43.15
|
|
|
BARRIER FILM CAVILON SPRAY
|
Facility
IP
|
$50.76
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION [23082]
|
Facility
OP
|
$5,155.45
|
|
|
Service Code
|
CPT J0480
|
| Hospital Charge Code |
1757346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,031.09 |
| Max. Negotiated Rate |
$27,739.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,476.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,739.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,595.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,923.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,923.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,782.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,046.18
|
| Rate for Payer: BCBS Transplant Transplant |
$3,093.27
|
| Rate for Payer: Blue Shield of California Commercial |
$5,191.22
|
| Rate for Payer: Blue Shield of California EPN |
$4,719.29
|
| Rate for Payer: Caremore Medicare Advantage |
$4,476.26
|
| Rate for Payer: Cash Price |
$2,319.95
|
| Rate for Payer: Cash Price |
$2,319.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,124.36
|
| Rate for Payer: Cigna of CA HMO |
$3,608.82
|
| Rate for Payer: Cigna of CA PPO |
$3,608.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,714.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,042.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,476.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,476.26
|
| Rate for Payer: Galaxy Health WC |
$4,382.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3,093.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,639.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,866.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,341.07
|
| Rate for Payer: IEHP medi-cal |
$7,385.84
|
| Rate for Payer: IEHP Medicare Advantage |
$4,476.26
|
| Rate for Payer: Innovage PACE Commercial |
$6,714.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,438.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,476.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,998.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,998.20
|
| Rate for Payer: Multiplan Commercial |
$3,866.59
|
| Rate for Payer: Networks By Design Commercial |
$2,577.72
|
| Rate for Payer: Prime Health Services Commercial |
$4,382.13
|
| Rate for Payer: Prime Health Services Medicare |
$4,744.84
|
| Rate for Payer: Riverside University Health MISP |
$4,923.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,093.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,093.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,577.72
|
| Rate for Payer: United Healthcare All Other HMO |
$2,577.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,577.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,577.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,714.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,923.89
|
| Rate for Payer: Vantage Medical Group Senior |
$4,476.26
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION [23082]
|
Facility
IP
|
$5,155.45
|
|
|
Service Code
|
CPT J0480
|
| Hospital Charge Code |
1757346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,031.09 |
| Max. Negotiated Rate |
$4,639.90 |
| Rate for Payer: Blue Shield of California Commercial |
$3,866.59
|
| Rate for Payer: Blue Shield of California EPN |
$2,753.01
|
| Rate for Payer: Cash Price |
$2,319.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,124.36
|
| Rate for Payer: Cigna of CA HMO |
$3,608.82
|
| Rate for Payer: Cigna of CA PPO |
$3,608.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,062.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,062.18
|
| Rate for Payer: Galaxy Health WC |
$4,382.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3,093.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,639.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,438.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.09
|
| Rate for Payer: Multiplan Commercial |
$3,866.59
|
| Rate for Payer: Networks By Design Commercial |
$2,577.72
|
| Rate for Payer: Prime Health Services Commercial |
$4,382.13
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION [117851]
|
Facility
OP
|
$188.48
|
|
|
Service Code
|
CPT J9030
|
| Hospital Charge Code |
1759920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$169.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$160.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$103.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$103.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.80
|
| Rate for Payer: BCBS Transplant Transplant |
$113.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4.15
|
| Rate for Payer: Blue Shield of California EPN |
$3.77
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Central Health Plan Commercial |
$150.78
|
| Rate for Payer: Cigna of CA HMO |
$131.94
|
| Rate for Payer: Cigna of CA PPO |
$131.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.39
|
| Rate for Payer: Galaxy Health WC |
$160.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$141.36
|
| Rate for Payer: IEHP medi-cal |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.70
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: Networks By Design Commercial |
$94.24
|
| Rate for Payer: Prime Health Services Commercial |
$160.21
|
| Rate for Payer: Riverside University Health MISP |
$75.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.24
|
| Rate for Payer: United Healthcare All Other HMO |
$94.24
|
| Rate for Payer: United Healthcare HMO Rider |
$94.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.21
|
| Rate for Payer: Vantage Medical Group Senior |
$160.21
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION [117851]
|
Facility
IP
|
$188.48
|
|
|
Service Code
|
CPT J9030
|
| Hospital Charge Code |
1759920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$169.63 |
| Rate for Payer: Blue Shield of California Commercial |
$141.36
|
| Rate for Payer: Blue Shield of California EPN |
$100.65
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Central Health Plan Commercial |
$150.78
|
| Rate for Payer: Cigna of CA HMO |
$131.94
|
| Rate for Payer: Cigna of CA PPO |
$131.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.39
|
| Rate for Payer: Galaxy Health WC |
$160.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.70
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: Networks By Design Commercial |
$94.24
|
| Rate for Payer: Prime Health Services Commercial |
$160.21
|
|
|
B-COMPLEX WITH VITAMIN C 1/2 TABLET [408807]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 8068112600
|
| Hospital Charge Code |
ERX408807
|
|
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
|
|
|
B-COMPLEX WITH VITAMIN C 1/2 TABLET [408807]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 9999-9998-07
|
| Hospital Charge Code |
NDC408807
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
B-COMPLEX WITH VITAMIN C 1/2 TABLET [408807]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 9999-9998-07
|
| Hospital Charge Code |
NDC408807
|
|
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
|
|
|
B-COMPLEX WITH VITAMIN C 1/2 TABLET [408807]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
ERX408807
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
B-COMPLEX WITH VITAMIN C 1/2 TABLET [408807]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
ERX408807
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
