|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
IP
|
$0.61
|
|
|
Service Code
|
NDC 0527-1356-01
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
NDC 0527-1356-01
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
OP
|
$0.55
|
|
|
Service Code
|
NDC 65162-573-10
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: IEHP medi-cal |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: BCBS Transplant Transplant |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
IP
|
$0.55
|
|
|
Service Code
|
NDC 65162-573-10
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
OP
|
$1.09
|
|
|
Service Code
|
NDC 0832-0512-89
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: BCBS Transplant Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.82
|
| Rate for Payer: IEHP medi-cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: Riverside University Health MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
NDC 0832-0512-89
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
OP
|
$0.55
|
|
|
Service Code
|
NDC 0832-0512-00
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: BCBS Transplant Transplant |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.41
|
| Rate for Payer: IEHP medi-cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
IP
|
$0.55
|
|
|
Service Code
|
NDC 0832-0512-00
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
IP
|
$1.10
|
|
|
Service Code
|
NDC 0832-0512-01
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
OP
|
$1.10
|
|
|
Service Code
|
NDC 0832-0512-01
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: BCBS Transplant Transplant |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.88
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$0.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.83
|
| Rate for Payer: IEHP medi-cal |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: Riverside University Health MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
BETHANECHOL CHLORIDE 5 MG TABLET [1045]
|
Facility
OP
|
$0.29
|
|
|
Service Code
|
NDC 0832-0510-00
|
| Hospital Charge Code |
1711212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.16
|
| 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: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| 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: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.22
|
| Rate for Payer: IEHP medi-cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: Riverside University Health 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 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 0832-0510-00
|
| Hospital Charge Code |
1711212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.19
|
| 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 9994-0802-48
|
| Hospital Charge Code |
1715519
|
|
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
|
|
|
BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0802-48
|
| Hospital Charge Code |
1715519
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$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: 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
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
IP
|
$239.08
|
|
|
Service Code
|
CPT J9035
|
| Hospital Charge Code |
1722041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$179.31
|
| Rate for Payer: Blue Shield of California EPN |
$127.67
|
| 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: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$159.47
|
| 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
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
IP
|
$239.08
|
|
|
Service Code
|
CPT J9035
|
| Hospital Charge Code |
1722042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$179.31
|
| Rate for Payer: Blue Shield of California EPN |
$127.67
|
| 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: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$159.47
|
| 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
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
OP
|
$239.08
|
|
|
Service Code
|
CPT J9035
|
| Hospital Charge Code |
1722041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$74.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.16
|
| Rate for Payer: BCBS Transplant Transplant |
$143.45
|
| Rate for Payer: Blue Shield of California Commercial |
$105.19
|
| Rate for Payer: Blue Shield of California EPN |
$95.63
|
| Rate for Payer: Caremore Medicare Advantage |
$74.07
|
| 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 |
$111.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$74.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$74.07
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$179.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$121.48
|
| Rate for Payer: IEHP medi-cal |
$122.22
|
| Rate for Payer: IEHP Medicare Advantage |
$74.07
|
| Rate for Payer: Innovage PACE Commercial |
$111.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.26
|
| 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: Prime Health Services Medicare |
$78.52
|
| Rate for Payer: Riverside University Health MISP |
$81.48
|
| 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 |
$111.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.48
|
| Rate for Payer: Vantage Medical Group Senior |
$74.07
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
OP
|
$239.08
|
|
|
Service Code
|
CPT J9035
|
| Hospital Charge Code |
1722042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$74.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.16
|
| Rate for Payer: BCBS Transplant Transplant |
$143.45
|
| Rate for Payer: Blue Shield of California Commercial |
$105.19
|
| Rate for Payer: Blue Shield of California EPN |
$95.63
|
| Rate for Payer: Caremore Medicare Advantage |
$74.07
|
| 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 |
$111.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$74.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$74.07
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$179.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$121.48
|
| Rate for Payer: IEHP medi-cal |
$122.22
|
| Rate for Payer: IEHP Medicare Advantage |
$74.07
|
| Rate for Payer: Innovage PACE Commercial |
$111.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.26
|
| 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: Prime Health Services Medicare |
$78.52
|
| Rate for Payer: Riverside University Health MISP |
$81.48
|
| 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 |
$111.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.48
|
| Rate for Payer: Vantage Medical Group Senior |
$74.07
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]
|
Facility
IP
|
$239.08
|
|
|
Service Code
|
CPT C9257
|
| Hospital Charge Code |
1722041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$179.31
|
| Rate for Payer: Blue Shield of California EPN |
$127.67
|
| 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: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$159.47
|
| 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
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]
|
Facility
OP
|
$239.08
|
|
|
Service Code
|
CPT C9257
|
| Hospital Charge Code |
1722041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.32
|
| Rate for Payer: BCBS Transplant Transplant |
$143.45
|
| Rate for Payer: Blue Shield of California Commercial |
$150.38
|
| Rate for Payer: Blue Shield of California EPN |
$116.91
|
| Rate for Payer: Caremore Medicare Advantage |
$1.85
|
| 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 |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.85
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$179.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.04
|
| Rate for Payer: IEHP medi-cal |
$3.06
|
| Rate for Payer: IEHP Medicare Advantage |
$1.85
|
| Rate for Payer: Innovage PACE Commercial |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.48
|
| 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: Prime Health Services Medicare |
$1.96
|
| Rate for Payer: Riverside University Health MISP |
$2.04
|
| 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 |
$2.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.85
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
OP
|
$239.08
|
|
|
Service Code
|
NDC 50242-060-01
|
| Hospital Charge Code |
1722041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$131.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$131.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.25
|
| Rate for Payer: BCBS Transplant Transplant |
$143.45
|
| Rate for Payer: Blue Shield of California Commercial |
$150.38
|
| Rate for Payer: Blue Shield of California EPN |
$116.91
|
| 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: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$179.31
|
| Rate for Payer: IEHP medi-cal |
$83.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$203.22
|
| Rate for Payer: Vantage Medical Group Senior |
$203.22
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
OP
|
$239.08
|
|
|
Service Code
|
NDC 9994-0810-93
|
| Hospital Charge Code |
NDC4081093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$131.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$131.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.25
|
| Rate for Payer: BCBS Transplant Transplant |
$143.45
|
| Rate for Payer: Blue Shield of California Commercial |
$150.38
|
| Rate for Payer: Blue Shield of California EPN |
$116.91
|
| 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: EPIC Health Plan Commercial |
$95.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$179.31
|
| Rate for Payer: IEHP medi-cal |
$83.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.47
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$143.45
|
| Rate for Payer: Riverside University Health 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 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
|
NDC 9994-0810-93
|
| Hospital Charge Code |
NDC4081093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$159.47
|
| 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 25 MG/ML TOPICAL [4081093]
|
Facility
IP
|
$239.08
|
|
|
Service Code
|
NDC 50242-060-01
|
| Hospital Charge Code |
1722041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$159.47
|
| 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
IP
|
$209.32
|
|
|
Service Code
|
NDC 55513-206-01
|
| Hospital Charge Code |
NDG225272A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$156.99
|
| Rate for Payer: Blue Shield of California EPN |
$111.78
|
| 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: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$139.62
|
| 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
|
|
