|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
IP
|
$0.76
|
|
|
Service Code
|
NDC 0832051189
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 0832051100
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 0832051189
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: Riverside University Health System MISP |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 0832051100
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Riverside University Health System MISP |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
NDC 6068770011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Senior |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Riverside University Health System MISP |
$0.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
NDC 6068770001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Senior |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
NDC 6068770001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Senior |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
| Rate for Payer: Riverside University Health System MISP |
$0.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO |
$0.56
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
NDC 6068770011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Senior |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$0.95
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.95
|
|
|
BETHANECHOL CHLORIDE 5 MG TABLET [1045]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 0832051000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
BETHANECHOL CHLORIDE 5 MG TABLET [1045]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 0832051000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 9994080248
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| 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: 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: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994080248
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| 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
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Blue Shield of California Commercial |
$191.74
|
| Rate for Payer: Blue Shield of California EPN |
$120.50
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Senior |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$74.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.51
|
| Rate for Payer: Blue Shield of California Commercial |
$105.19
|
| Rate for Payer: Blue Shield of California EPN |
$95.63
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.45
|
| Rate for Payer: EPIC Health Plan Senior |
$82.30
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$122.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.26
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$74.82
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: Prime Health Services Medicare |
$79.31
|
| Rate for Payer: Riverside University Health System MISP |
$82.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$74.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Vantage Medical Group Senior |
$82.30
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$74.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.51
|
| Rate for Payer: Blue Shield of California Commercial |
$105.19
|
| Rate for Payer: Blue Shield of California EPN |
$95.63
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.45
|
| Rate for Payer: EPIC Health Plan Senior |
$82.30
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$122.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.26
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$74.82
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: Prime Health Services Medicare |
$79.31
|
| Rate for Payer: Riverside University Health System MISP |
$82.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$74.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Vantage Medical Group Senior |
$82.30
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Blue Shield of California Commercial |
$191.74
|
| Rate for Payer: Blue Shield of California EPN |
$120.50
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Senior |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$74.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.51
|
| Rate for Payer: Blue Shield of California Commercial |
$105.19
|
| Rate for Payer: Blue Shield of California EPN |
$95.63
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.45
|
| Rate for Payer: EPIC Health Plan Senior |
$82.30
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$122.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.26
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$74.82
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: Prime Health Services Medicare |
$79.31
|
| Rate for Payer: Riverside University Health System MISP |
$82.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$74.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Vantage Medical Group Senior |
$82.30
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
NDC 9994081093
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.07
|
| Rate for Payer: Blue Shield of California Commercial |
$151.58
|
| Rate for Payer: Blue Shield of California EPN |
$95.39
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$153.01
|
| Rate for Payer: Cigna of CA PPO |
$176.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$203.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Senior |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$167.36
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$155.40
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: Riverside University Health System MISP |
$95.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.54
|
| Rate for Payer: United Healthcare All Other HMO |
$119.54
|
| Rate for Payer: United Healthcare HMO Rider |
$119.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.22
|
| Rate for Payer: Vantage Medical Group Senior |
$203.22
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Blue Shield of California Commercial |
$191.74
|
| Rate for Payer: Blue Shield of California EPN |
$120.50
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Cigna of CA HMO |
$167.36
|
| Rate for Payer: Cigna of CA PPO |
$167.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Senior |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$119.54
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.73
|
| Rate for Payer: United Healthcare All Other HMO |
$87.34
|
| Rate for Payer: United Healthcare HMO Rider |
$85.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.30
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
NDC 9994081093
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Blue Shield of California Commercial |
$191.74
|
| Rate for Payer: Blue Shield of California EPN |
$120.50
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Central Health Plan Commercial |
$191.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Senior |
$95.63
|
| Rate for Payer: Galaxy Health WC |
$203.22
|
| Rate for Payer: Global Benefits Group Commercial |
$143.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: Networks By Design Commercial |
$155.40
|
| Rate for Payer: Prime Health Services Commercial |
$203.22
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
OP
|
$209.32
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Adventist Health Commercial |
$41.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$148.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.69
|
| Rate for Payer: Blue Shield of California Commercial |
$92.10
|
| Rate for Payer: Blue Shield of California EPN |
$83.73
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Central Health Plan Commercial |
$167.46
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$146.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.47
|
| Rate for Payer: EPIC Health Plan Senior |
$26.98
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$188.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.87
|
| Rate for Payer: Multiplan Commercial |
$156.99
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.53
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: Prime Health Services Medicare |
$26.00
|
| Rate for Payer: Riverside University Health System MISP |
$26.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$125.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$125.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.56
|
| Rate for Payer: United Healthcare All Other HMO |
$76.46
|
| Rate for Payer: United Healthcare HMO Rider |
$74.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.98
|
| Rate for Payer: Vantage Medical Group Senior |
$26.98
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
IP
|
$209.32
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$188.39 |
| Rate for Payer: Adventist Health Commercial |
$41.86
|
| Rate for Payer: Blue Shield of California Commercial |
$167.87
|
| Rate for Payer: Blue Shield of California EPN |
$105.50
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Central Health Plan Commercial |
$167.46
|
| Rate for Payer: Cigna of CA HMO |
$146.52
|
| Rate for Payer: Cigna of CA PPO |
$146.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$146.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Senior |
$83.73
|
| Rate for Payer: Galaxy Health WC |
$177.92
|
| Rate for Payer: Global Benefits Group Commercial |
$125.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$188.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.86
|
| Rate for Payer: Multiplan Commercial |
$156.99
|
| Rate for Payer: Networks By Design Commercial |
$104.66
|
| Rate for Payer: Prime Health Services Commercial |
$177.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.56
|
| Rate for Payer: United Healthcare All Other HMO |
$76.46
|
| Rate for Payer: United Healthcare HMO Rider |
$74.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.55
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [216412]
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$91.43
|
| Rate for Payer: Blue Shield of California EPN |
$57.46
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$79.80
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$57.00
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.78
|
| Rate for Payer: United Healthcare All Other HMO |
$41.64
|
| Rate for Payer: United Healthcare HMO Rider |
$40.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.34
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [216412]
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$247.08 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$39.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.80
|
| Rate for Payer: Blue Shield of California Commercial |
$50.16
|
| Rate for Payer: Blue Shield of California EPN |
$45.60
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$79.80
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.72
|
| Rate for Payer: EPIC Health Plan Senior |
$43.81
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$65.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.37
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$57.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$39.83
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Prime Health Services Medicare |
$42.22
|
| Rate for Payer: Riverside University Health System MISP |
$43.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.78
|
| Rate for Payer: United Healthcare All Other HMO |
$41.64
|
| Rate for Payer: United Healthcare HMO Rider |
$40.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$39.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.81
|
| Rate for Payer: Vantage Medical Group Senior |
$43.81
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 4161648583
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| 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: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| 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: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
