|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$5.60
|
|
|
Service Code
|
NDC 60687-524-83
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| 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 |
$4.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.99
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$5.58
|
|
|
Service Code
|
NDC 0487-9701-01
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| 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 |
$4.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Central Health Plan Commercial |
$4.46
|
| Rate for Payer: Cigna of CA HMO |
$3.91
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.18
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 68180-984-30
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 68180-984-30
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$5.60
|
|
|
Service Code
|
NDC 60687-524-79
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| 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 |
$4.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.99
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 68180-984-05
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 68180-984-05
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$21.89
|
|
|
Service Code
|
NDC 51079-020-03
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$19.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: BCBS Transplant Transplant |
$13.13
|
| Rate for Payer: Blue Shield of California Commercial |
$13.77
|
| Rate for Payer: Blue Shield of California EPN |
$10.70
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Central Health Plan Commercial |
$17.51
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$15.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.42
|
| Rate for Payer: IEHP medi-cal |
$7.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: Riverside University Health MISP |
$8.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.94
|
| Rate for Payer: United Healthcare All Other HMO |
$10.94
|
| Rate for Payer: United Healthcare HMO Rider |
$10.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$21.89
|
|
|
Service Code
|
NDC 51079-020-03
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.38 |
| 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 |
$16.42
|
| Rate for Payer: Blue Shield of California EPN |
$11.69
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Central Health Plan Commercial |
$17.51
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$21.89
|
|
|
Service Code
|
NDC 51079-020-01
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$19.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.93
|
| Rate for Payer: BCBS Transplant Transplant |
$13.13
|
| Rate for Payer: Blue Shield of California Commercial |
$13.77
|
| Rate for Payer: Blue Shield of California EPN |
$10.70
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Central Health Plan Commercial |
$17.51
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$15.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.42
|
| Rate for Payer: IEHP medi-cal |
$7.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: Riverside University Health MISP |
$8.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.94
|
| Rate for Payer: United Healthcare All Other HMO |
$10.94
|
| Rate for Payer: United Healthcare HMO Rider |
$10.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$16.20
|
|
|
Service Code
|
NDC 60687-596-33
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.57
|
| Rate for Payer: BCBS Transplant Transplant |
$9.72
|
| Rate for Payer: Blue Shield of California Commercial |
$10.19
|
| Rate for Payer: Blue Shield of California EPN |
$7.92
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Central Health Plan Commercial |
$12.96
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.15
|
| Rate for Payer: IEHP medi-cal |
$5.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: Riverside University Health MISP |
$6.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO |
$8.10
|
| Rate for Payer: United Healthcare HMO Rider |
$8.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.77
|
| Rate for Payer: Vantage Medical Group Senior |
$13.77
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$16.20
|
|
|
Service Code
|
NDC 60687-596-33
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| 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 |
$12.15
|
| Rate for Payer: Blue Shield of California EPN |
$8.65
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Central Health Plan Commercial |
$12.96
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$16.20
|
|
|
Service Code
|
NDC 60687-596-32
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.57
|
| Rate for Payer: BCBS Transplant Transplant |
$9.72
|
| Rate for Payer: Blue Shield of California Commercial |
$10.19
|
| Rate for Payer: Blue Shield of California EPN |
$7.92
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Central Health Plan Commercial |
$12.96
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.15
|
| Rate for Payer: IEHP medi-cal |
$5.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: Riverside University Health MISP |
$6.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO |
$8.10
|
| Rate for Payer: United Healthcare HMO Rider |
$8.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.77
|
| Rate for Payer: Vantage Medical Group Senior |
$13.77
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$16.20
|
|
|
Service Code
|
NDC 60687-596-32
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.24 |
| 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 |
$12.15
|
| Rate for Payer: Blue Shield of California EPN |
$8.65
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Central Health Plan Commercial |
$12.96
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.15
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$21.89
|
|
|
Service Code
|
NDC 51079-020-01
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.38 |
| 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 |
$16.42
|
| Rate for Payer: Blue Shield of California EPN |
$11.69
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Central Health Plan Commercial |
$17.51
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$1.19
|
|
|
Service Code
|
NDC 0574-9855-10
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.89
|
| Rate for Payer: IEHP medi-cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: Riverside University Health MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1.01
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$1.19
|
|
|
Service Code
|
NDC 0574-9855-10
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| 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 |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81454]
|
Facility
OP
|
$53.07
|
|
|
Service Code
|
NDC 0186-0370-28
|
| Hospital Charge Code |
1744122
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.35
|
| Rate for Payer: BCBS Transplant Transplant |
$31.84
|
| Rate for Payer: Blue Shield of California Commercial |
$33.38
|
| Rate for Payer: Blue Shield of California EPN |
$25.95
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Central Health Plan Commercial |
$42.46
|
| Rate for Payer: Cigna of CA HMO |
$37.15
|
| Rate for Payer: Cigna of CA PPO |
$37.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.23
|
| Rate for Payer: Galaxy Health WC |
$45.11
|
| Rate for Payer: Global Benefits Group Commercial |
$31.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.80
|
| Rate for Payer: IEHP medi-cal |
$18.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.61
|
| Rate for Payer: Multiplan Commercial |
$39.80
|
| Rate for Payer: Networks By Design Commercial |
$34.50
|
| Rate for Payer: Prime Health Services Commercial |
$45.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.84
|
| Rate for Payer: Riverside University Health MISP |
$21.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.54
|
| Rate for Payer: United Healthcare All Other HMO |
$26.54
|
| Rate for Payer: United Healthcare HMO Rider |
$26.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.11
|
| Rate for Payer: Vantage Medical Group Senior |
$45.11
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81454]
|
Facility
IP
|
$53.07
|
|
|
Service Code
|
NDC 0186-0370-28
|
| Hospital Charge Code |
1744122
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.61 |
| 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 |
$39.80
|
| Rate for Payer: Blue Shield of California EPN |
$28.34
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Central Health Plan Commercial |
$42.46
|
| Rate for Payer: Cigna of CA HMO |
$37.15
|
| Rate for Payer: Cigna of CA PPO |
$37.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.23
|
| Rate for Payer: Galaxy Health WC |
$45.11
|
| Rate for Payer: Global Benefits Group Commercial |
$31.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.61
|
| Rate for Payer: Multiplan Commercial |
$39.80
|
| Rate for Payer: Networks By Design Commercial |
$34.50
|
| Rate for Payer: Prime Health Services Commercial |
$45.11
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]
|
Facility
IP
|
$40.12
|
|
|
Service Code
|
NDC 0186-0372-28
|
| Hospital Charge Code |
1744123
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.02 |
| 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 |
$30.09
|
| Rate for Payer: Blue Shield of California EPN |
$21.42
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Central Health Plan Commercial |
$32.10
|
| Rate for Payer: Cigna of CA HMO |
$28.08
|
| Rate for Payer: Cigna of CA PPO |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.05
|
| Rate for Payer: Galaxy Health WC |
$34.10
|
| Rate for Payer: Global Benefits Group Commercial |
$24.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$30.09
|
| Rate for Payer: Networks By Design Commercial |
$26.08
|
| Rate for Payer: Prime Health Services Commercial |
$34.10
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]
|
Facility
OP
|
$40.19
|
|
|
Service Code
|
NDC 0186-0372-20
|
| Hospital Charge Code |
NDG81453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$36.17 |
| Rate for Payer: IEHP medi-cal |
$14.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.74
|
| Rate for Payer: BCBS Transplant Transplant |
$24.11
|
| Rate for Payer: Blue Shield of California Commercial |
$25.28
|
| Rate for Payer: Blue Shield of California EPN |
$19.65
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Central Health Plan Commercial |
$32.15
|
| Rate for Payer: Cigna of CA HMO |
$28.13
|
| Rate for Payer: Cigna of CA PPO |
$28.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.08
|
| Rate for Payer: Galaxy Health WC |
$34.16
|
| Rate for Payer: Global Benefits Group Commercial |
$24.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.04
|
| Rate for Payer: Multiplan Commercial |
$30.14
|
| Rate for Payer: Networks By Design Commercial |
$26.12
|
| Rate for Payer: Prime Health Services Commercial |
$34.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.11
|
| Rate for Payer: Riverside University Health MISP |
$16.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.10
|
| Rate for Payer: United Healthcare All Other HMO |
$20.10
|
| Rate for Payer: United Healthcare HMO Rider |
$20.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.16
|
| Rate for Payer: Vantage Medical Group Senior |
$34.16
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]
|
Facility
IP
|
$40.19
|
|
|
Service Code
|
NDC 0186-0372-20
|
| Hospital Charge Code |
NDG81453
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.04 |
| 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 |
$30.14
|
| Rate for Payer: Blue Shield of California EPN |
$21.46
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Central Health Plan Commercial |
$32.15
|
| Rate for Payer: Cigna of CA HMO |
$28.13
|
| Rate for Payer: Cigna of CA PPO |
$28.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.08
|
| Rate for Payer: Galaxy Health WC |
$34.16
|
| Rate for Payer: Global Benefits Group Commercial |
$24.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.04
|
| Rate for Payer: Multiplan Commercial |
$30.14
|
| Rate for Payer: Networks By Design Commercial |
$26.12
|
| Rate for Payer: Prime Health Services Commercial |
$34.16
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER [81453]
|
Facility
OP
|
$40.12
|
|
|
Service Code
|
NDC 0186-0372-28
|
| Hospital Charge Code |
1744123
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$36.11 |
| Rate for Payer: IEHP medi-cal |
$14.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.70
|
| Rate for Payer: BCBS Transplant Transplant |
$24.07
|
| Rate for Payer: Blue Shield of California Commercial |
$25.24
|
| Rate for Payer: Blue Shield of California EPN |
$19.62
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Central Health Plan Commercial |
$32.10
|
| Rate for Payer: Cigna of CA HMO |
$28.08
|
| Rate for Payer: Cigna of CA PPO |
$28.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.05
|
| Rate for Payer: Galaxy Health WC |
$34.10
|
| Rate for Payer: Global Benefits Group Commercial |
$24.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$30.09
|
| Rate for Payer: Networks By Design Commercial |
$26.08
|
| Rate for Payer: Prime Health Services Commercial |
$34.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.07
|
| Rate for Payer: Riverside University Health MISP |
$16.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.06
|
| Rate for Payer: United Healthcare All Other HMO |
$20.06
|
| Rate for Payer: United Healthcare HMO Rider |
$20.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.10
|
| Rate for Payer: Vantage Medical Group Senior |
$34.10
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
CPT S0171
|
| Hospital Charge Code |
1720423
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: BCBS Transplant Transplant |
$0.24
|
| Rate for Payer: BCBS Transplant Transplant |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.30
|
| Rate for Payer: IEHP medi-cal |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION [9308]
|
Facility
IP
|
$0.39
|
|
|
Service Code
|
CPT S0171
|
| Hospital Charge Code |
1720423
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
