|
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 TABLET [807]
|
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 TABLET [807]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
1711835
|
|
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 TABLET [807]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 8068112600
|
| Hospital Charge Code |
1711835
|
|
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 TABLET [807]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 8068112600
|
| Hospital Charge Code |
1711835
|
|
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 TABLET [807]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 3160401338
|
| Hospital Charge Code |
1711835
|
|
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
|
|
|
B-COMPLEX WITH VITAMIN C TABLET [807]
|
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
|
|
|
BEBTELOVIMAB 175 MG/2 ML (87.5 MG/ML) INTRAVENOUS SOLUTION (UNAPP) [233528]
|
Facility
OP
|
$1,260.00
|
|
|
Service Code
|
CPT Q0222
|
| Hospital Charge Code |
NDG233528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$14,688.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,139.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14,688.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,924.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,453.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,453.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$610.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$744.41
|
| Rate for Payer: BCBS Transplant Transplant |
$756.00
|
| Rate for Payer: Blue Shield of California Commercial |
$792.54
|
| Rate for Payer: Blue Shield of California EPN |
$616.14
|
| Rate for Payer: Caremore Medicare Advantage |
$3,139.35
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,008.00
|
| Rate for Payer: Cigna of CA HMO |
$882.00
|
| Rate for Payer: Cigna of CA PPO |
$882.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,709.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,238.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,139.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,139.35
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,134.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$945.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,148.53
|
| Rate for Payer: IEHP medi-cal |
$5,179.93
|
| Rate for Payer: IEHP Medicare Advantage |
$3,139.35
|
| Rate for Payer: Innovage PACE Commercial |
$4,709.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,139.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,206.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,206.73
|
| Rate for Payer: Multiplan Commercial |
$945.00
|
| Rate for Payer: Networks By Design Commercial |
$630.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Prime Health Services Medicare |
$3,327.71
|
| Rate for Payer: Riverside University Health MISP |
$3,453.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$630.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$630.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,709.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,453.28
|
| Rate for Payer: Vantage Medical Group Senior |
$3,139.35
|
|
|
BEBTELOVIMAB 175 MG/2 ML (87.5 MG/ML) INTRAVENOUS SOLUTION (UNAPP) [233528]
|
Facility
IP
|
$1,260.00
|
|
|
Service Code
|
CPT Q0222
|
| Hospital Charge Code |
NDG233528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Blue Shield of California Commercial |
$945.00
|
| Rate for Payer: Blue Shield of California EPN |
$672.84
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,008.00
|
| Rate for Payer: Cigna of CA HMO |
$882.00
|
| Rate for Payer: Cigna of CA PPO |
$882.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,134.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$945.00
|
| Rate for Payer: Networks By Design Commercial |
$630.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0802-47
|
| Hospital Charge Code |
1715210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| 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 |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| 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 |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| 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 |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0802-47
|
| Hospital Charge Code |
1715210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| 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 |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
BEER [4080757]
|
Facility
OP
|
$1.43
|
|
|
Service Code
|
NDC 9994-0807-57
|
| Hospital Charge Code |
ERX4080757
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.07
|
| Rate for Payer: IEHP medi-cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health MISP |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
BEER [4080757]
|
Facility
IP
|
$1.43
|
|
|
Service Code
|
NDC 9994-0807-57
|
| Hospital Charge Code |
ERX4080757
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
BEHAVIORAL DISORDERS
|
Facility
IP
|
$12,536.08
|
|
|
Service Code
|
APR-DRG 7584
|
| Min. Negotiated Rate |
$10,519.79 |
| Max. Negotiated Rate |
$12,536.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,519.79
|
| Rate for Payer: IEHP medi-cal |
$12,536.08
|
|
|
BEHAVIORAL DISORDERS
|
Facility
IP
|
$4,403.38
|
|
|
Service Code
|
APR-DRG 7581
|
| Min. Negotiated Rate |
$3,695.15 |
| Max. Negotiated Rate |
$4,403.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,695.15
|
| Rate for Payer: IEHP medi-cal |
$4,403.38
|
|
|
BEHAVIORAL DISORDERS
|
Facility
IP
|
$9,498.16
|
|
|
Service Code
|
APR-DRG 7583
|
| Min. Negotiated Rate |
$7,970.48 |
| Max. Negotiated Rate |
$9,498.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,970.48
|
| Rate for Payer: IEHP medi-cal |
$9,498.16
|
|
|
BEHAVIORAL DISORDERS
|
Facility
IP
|
$5,447.17
|
|
|
Service Code
|
APR-DRG 7582
|
| Min. Negotiated Rate |
$4,571.05 |
| Max. Negotiated Rate |
$5,447.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,571.05
|
| Rate for Payer: IEHP medi-cal |
$5,447.17
|
|
|
BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION [229004]
|
Facility
OP
|
$10,591.76
|
|
|
Service Code
|
CPT J9037
|
| Hospital Charge Code |
ERX229004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.78 |
| Max. Negotiated Rate |
$9,532.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$46.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.67
|
| Rate for Payer: BCBS Transplant Transplant |
$6,355.06
|
| Rate for Payer: Blue Shield of California Commercial |
$6,662.22
|
| Rate for Payer: Blue Shield of California EPN |
$5,179.37
|
| Rate for Payer: Caremore Medicare Advantage |
$46.78
|
| Rate for Payer: Cash Price |
$4,766.29
|
| Rate for Payer: Cash Price |
$4,766.29
|
| Rate for Payer: Central Health Plan Commercial |
$8,473.41
|
| Rate for Payer: Cigna of CA HMO |
$7,414.23
|
| Rate for Payer: Cigna of CA PPO |
$7,414.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$46.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.78
|
| Rate for Payer: Galaxy Health WC |
$9,003.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,355.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,532.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,943.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$76.72
|
| Rate for Payer: IEHP medi-cal |
$77.19
|
| Rate for Payer: IEHP Medicare Advantage |
$46.78
|
| Rate for Payer: Innovage PACE Commercial |
$70.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,064.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.69
|
| Rate for Payer: Multiplan Commercial |
$7,943.82
|
| Rate for Payer: Networks By Design Commercial |
$5,295.88
|
| Rate for Payer: Prime Health Services Commercial |
$9,003.00
|
| Rate for Payer: Prime Health Services Medicare |
$49.59
|
| Rate for Payer: Riverside University Health MISP |
$51.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,355.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,355.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,295.88
|
| Rate for Payer: United Healthcare HMO Rider |
$5,295.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,295.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.46
|
| Rate for Payer: Vantage Medical Group Senior |
$51.46
|
|
|
BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION [229004]
|
Facility
IP
|
$10,591.76
|
|
|
Service Code
|
CPT J9037
|
| Hospital Charge Code |
ERX229004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,118.35 |
| Max. Negotiated Rate |
$9,532.58 |
| Rate for Payer: Blue Shield of California Commercial |
$7,943.82
|
| Rate for Payer: Blue Shield of California EPN |
$5,656.00
|
| Rate for Payer: Cash Price |
$4,766.29
|
| Rate for Payer: Central Health Plan Commercial |
$8,473.41
|
| Rate for Payer: Cigna of CA HMO |
$7,414.23
|
| Rate for Payer: Cigna of CA PPO |
$7,414.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,236.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,236.70
|
| Rate for Payer: Galaxy Health WC |
$9,003.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,355.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,532.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,064.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.35
|
| Rate for Payer: Multiplan Commercial |
$7,943.82
|
| Rate for Payer: Networks By Design Commercial |
$5,295.88
|
| Rate for Payer: Prime Health Services Commercial |
$9,003.00
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION [153042]
|
Facility
OP
|
$1,163.86
|
|
|
Service Code
|
CPT J0485
|
| Hospital Charge Code |
ERX153042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$1,047.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.01
|
| Rate for Payer: BCBS Transplant Transplant |
$698.32
|
| Rate for Payer: Blue Shield of California Commercial |
$4.99
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Caremore Medicare Advantage |
$3.87
|
| Rate for Payer: Cash Price |
$523.74
|
| Rate for Payer: Cash Price |
$523.74
|
| Rate for Payer: Central Health Plan Commercial |
$931.09
|
| Rate for Payer: Cigna of CA HMO |
$814.70
|
| Rate for Payer: Cigna of CA PPO |
$814.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.87
|
| Rate for Payer: Galaxy Health WC |
$989.28
|
| Rate for Payer: Global Benefits Group Commercial |
$698.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,047.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$872.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.35
|
| Rate for Payer: IEHP medi-cal |
$6.39
|
| Rate for Payer: IEHP Medicare Advantage |
$3.87
|
| Rate for Payer: Innovage PACE Commercial |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.19
|
| Rate for Payer: Multiplan Commercial |
$872.90
|
| Rate for Payer: Networks By Design Commercial |
$581.93
|
| Rate for Payer: Prime Health Services Commercial |
$989.28
|
| Rate for Payer: Prime Health Services Medicare |
$4.11
|
| Rate for Payer: Riverside University Health MISP |
$4.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$698.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$698.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.93
|
| Rate for Payer: United Healthcare All Other HMO |
$581.93
|
| Rate for Payer: United Healthcare HMO Rider |
$581.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.26
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION [153042]
|
Facility
IP
|
$1,163.86
|
|
|
Service Code
|
CPT J0485
|
| Hospital Charge Code |
ERX153042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.77 |
| Max. Negotiated Rate |
$1,047.47 |
| Rate for Payer: Blue Shield of California Commercial |
$872.90
|
| Rate for Payer: Blue Shield of California EPN |
$621.50
|
| Rate for Payer: Cash Price |
$523.74
|
| Rate for Payer: Central Health Plan Commercial |
$931.09
|
| Rate for Payer: Cigna of CA HMO |
$814.70
|
| Rate for Payer: Cigna of CA PPO |
$814.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$465.54
|
| Rate for Payer: Galaxy Health WC |
$989.28
|
| Rate for Payer: Global Benefits Group Commercial |
$698.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,047.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.77
|
| Rate for Payer: Multiplan Commercial |
$872.90
|
| Rate for Payer: Networks By Design Commercial |
$581.93
|
| Rate for Payer: Prime Health Services Commercial |
$989.28
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]
|
Facility
OP
|
$707.42
|
|
|
Service Code
|
CPT J0490
|
| Hospital Charge Code |
1755787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$636.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$52.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$322.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.06
|
| Rate for Payer: BCBS Transplant Transplant |
$424.45
|
| Rate for Payer: Blue Shield of California Commercial |
$59.61
|
| Rate for Payer: Blue Shield of California EPN |
$54.19
|
| Rate for Payer: Caremore Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$318.34
|
| Rate for Payer: Cash Price |
$318.34
|
| Rate for Payer: Central Health Plan Commercial |
$565.94
|
| Rate for Payer: Cigna of CA HMO |
$495.19
|
| Rate for Payer: Cigna of CA PPO |
$495.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$52.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$601.31
|
| Rate for Payer: Global Benefits Group Commercial |
$424.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$636.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$530.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$85.28
|
| Rate for Payer: IEHP medi-cal |
$85.80
|
| Rate for Payer: IEHP Medicare Advantage |
$52.00
|
| Rate for Payer: Innovage PACE Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$471.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.68
|
| Rate for Payer: Multiplan Commercial |
$530.56
|
| Rate for Payer: Networks By Design Commercial |
$353.71
|
| Rate for Payer: Prime Health Services Commercial |
$601.31
|
| Rate for Payer: Prime Health Services Medicare |
$55.12
|
| Rate for Payer: Riverside University Health MISP |
$57.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$424.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$424.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$353.71
|
| Rate for Payer: United Healthcare All Other HMO |
$353.71
|
| Rate for Payer: United Healthcare HMO Rider |
$353.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$353.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Vantage Medical Group Senior |
$52.00
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]
|
Facility
IP
|
$707.42
|
|
|
Service Code
|
CPT J0490
|
| Hospital Charge Code |
1755787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.48 |
| Max. Negotiated Rate |
$636.68 |
| Rate for Payer: Blue Shield of California Commercial |
$530.56
|
| Rate for Payer: Blue Shield of California EPN |
$377.76
|
| Rate for Payer: Cash Price |
$318.34
|
| Rate for Payer: Central Health Plan Commercial |
$565.94
|
| Rate for Payer: Cigna of CA HMO |
$495.19
|
| Rate for Payer: Cigna of CA PPO |
$495.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$282.97
|
| Rate for Payer: Galaxy Health WC |
$601.31
|
| Rate for Payer: Global Benefits Group Commercial |
$424.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$636.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$471.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.48
|
| Rate for Payer: Multiplan Commercial |
$530.56
|
| Rate for Payer: Networks By Design Commercial |
$353.71
|
| Rate for Payer: Prime Health Services Commercial |
$601.31
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION [108843]
|
Facility
IP
|
$2,357.96
|
|
|
Service Code
|
CPT J0490
|
| Hospital Charge Code |
1755788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$471.59 |
| Max. Negotiated Rate |
$2,122.16 |
| Rate for Payer: Blue Shield of California Commercial |
$1,768.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,259.15
|
| Rate for Payer: Cash Price |
$1,061.08
|
| Rate for Payer: Central Health Plan Commercial |
$1,886.37
|
| Rate for Payer: Cigna of CA HMO |
$1,650.57
|
| Rate for Payer: Cigna of CA PPO |
$1,650.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$943.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$943.18
|
| Rate for Payer: Galaxy Health WC |
$2,004.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1,414.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,122.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,572.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.59
|
| Rate for Payer: Multiplan Commercial |
$1,768.47
|
| Rate for Payer: Networks By Design Commercial |
$1,178.98
|
| Rate for Payer: Prime Health Services Commercial |
$2,004.27
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION [108843]
|
Facility
OP
|
$2,357.96
|
|
|
Service Code
|
CPT J0490
|
| Hospital Charge Code |
1755788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$2,122.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$52.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$322.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.06
|
| Rate for Payer: BCBS Transplant Transplant |
$1,414.78
|
| Rate for Payer: Blue Shield of California Commercial |
$59.61
|
| Rate for Payer: Blue Shield of California EPN |
$54.19
|
| Rate for Payer: Caremore Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$1,061.08
|
| Rate for Payer: Cash Price |
$1,061.08
|
| Rate for Payer: Central Health Plan Commercial |
$1,886.37
|
| Rate for Payer: Cigna of CA HMO |
$1,650.57
|
| Rate for Payer: Cigna of CA PPO |
$1,650.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$52.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$2,004.27
|
| Rate for Payer: Global Benefits Group Commercial |
$1,414.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,122.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,768.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$85.28
|
| Rate for Payer: IEHP medi-cal |
$85.80
|
| Rate for Payer: IEHP Medicare Advantage |
$52.00
|
| Rate for Payer: Innovage PACE Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,572.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.68
|
| Rate for Payer: Multiplan Commercial |
$1,768.47
|
| Rate for Payer: Networks By Design Commercial |
$1,178.98
|
| Rate for Payer: Prime Health Services Commercial |
$2,004.27
|
| Rate for Payer: Prime Health Services Medicare |
$55.12
|
| Rate for Payer: Riverside University Health MISP |
$57.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,414.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,414.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,178.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1,178.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,178.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,178.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Vantage Medical Group Senior |
$52.00
|
|
