|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 4354768610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 7001004401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Riverside University Health System MISP |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 5167242221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 4219595510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 4219595510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| 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 |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.92
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.92
|
| Rate for Payer: Riverside University Health System MISP |
$0.43
|
| 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 |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 5167242221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Riverside University Health System MISP |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-300 MG-40 MG CAPSULE [104993]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 7001004401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
|
|
BUTORPHANOL 10 MG/ML NASAL SPRAY [9335]
|
Facility
|
IP
|
$31.13
|
|
|
Service Code
|
NDC 6050508131
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Blue Shield of California Commercial |
$24.97
|
| Rate for Payer: Blue Shield of California EPN |
$15.69
|
| Rate for Payer: Cash Price |
$14.01
|
| Rate for Payer: Central Health Plan Commercial |
$24.90
|
| Rate for Payer: Cigna of CA HMO |
$21.79
|
| Rate for Payer: Cigna of CA PPO |
$21.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.45
|
| Rate for Payer: EPIC Health Plan Senior |
$12.45
|
| Rate for Payer: Galaxy Health WC |
$26.46
|
| Rate for Payer: Global Benefits Group Commercial |
$18.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$23.35
|
| Rate for Payer: Networks By Design Commercial |
$20.23
|
| Rate for Payer: Prime Health Services Commercial |
$26.46
|
|
|
BUTORPHANOL 10 MG/ML NASAL SPRAY [9335]
|
Facility
|
OP
|
$31.13
|
|
|
Service Code
|
NDC 6050508131
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.11
|
| Rate for Payer: Blue Shield of California Commercial |
$19.74
|
| Rate for Payer: Blue Shield of California EPN |
$12.42
|
| Rate for Payer: Cash Price |
$14.01
|
| Rate for Payer: Central Health Plan Commercial |
$24.90
|
| Rate for Payer: Cigna of CA HMO |
$21.79
|
| Rate for Payer: Cigna of CA PPO |
$21.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.45
|
| Rate for Payer: EPIC Health Plan Senior |
$12.45
|
| Rate for Payer: Galaxy Health WC |
$26.46
|
| Rate for Payer: Global Benefits Group Commercial |
$18.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$23.35
|
| Rate for Payer: Networks By Design Commercial |
$20.23
|
| Rate for Payer: Prime Health Services Commercial |
$26.46
|
| Rate for Payer: Riverside University Health System MISP |
$12.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.56
|
| Rate for Payer: United Healthcare All Other HMO |
$15.56
|
| Rate for Payer: United Healthcare HMO Rider |
$15.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.46
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION [9333]
|
Facility
|
IP
|
$25.35
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Blue Shield of California Commercial |
$20.33
|
| Rate for Payer: Blue Shield of California EPN |
$12.78
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Central Health Plan Commercial |
$20.28
|
| Rate for Payer: Cigna of CA HMO |
$17.75
|
| Rate for Payer: Cigna of CA PPO |
$17.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.55
|
| Rate for Payer: Global Benefits Group Commercial |
$15.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.01
|
| Rate for Payer: Networks By Design Commercial |
$12.68
|
| Rate for Payer: Prime Health Services Commercial |
$21.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.30
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION [9333]
|
Facility
|
OP
|
$25.35
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$29.08 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.06
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Central Health Plan Commercial |
$20.28
|
| Rate for Payer: Cigna of CA HMO |
$17.75
|
| Rate for Payer: Cigna of CA PPO |
$17.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.55
|
| Rate for Payer: Global Benefits Group Commercial |
$15.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$19.01
|
| Rate for Payer: Networks By Design Commercial |
$12.68
|
| Rate for Payer: Prime Health Services Commercial |
$21.55
|
| Rate for Payer: Riverside University Health System MISP |
$10.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.55
|
| Rate for Payer: Vantage Medical Group Senior |
$21.55
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
|
IP
|
$69.88
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$62.89 |
| Rate for Payer: Adventist Health Commercial |
$13.98
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$56.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$35.22
|
| Rate for Payer: Cash Price |
$31.45
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$55.90
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$48.92
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$48.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$27.95
|
| Rate for Payer: Galaxy Health WC |
$59.40
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$41.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$52.41
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$34.94
|
| Rate for Payer: Prime Health Services Commercial |
$59.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.23
|
| Rate for Payer: United Healthcare All Other HMO |
$25.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$24.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.89
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$29.08 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$13.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6.67
|
| Rate for Payer: Blue Shield of California Commercial |
$6.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.06
|
| Rate for Payer: Blue Shield of California EPN |
$6.06
|
| Rate for Payer: Cash Price |
$31.45
|
| Rate for Payer: Cash Price |
$31.45
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$55.90
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$48.92
|
| Rate for Payer: Cigna of CA PPO |
$48.92
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$27.95
|
| Rate for Payer: Galaxy Health WC |
$59.40
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$41.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.92
|
| Rate for Payer: Multiplan Commercial |
$52.41
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$34.94
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$59.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.95
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.23
|
| Rate for Payer: United Healthcare All Other HMO |
$25.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$24.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Vantage Medical Group Senior |
$59.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
BUTT PASTE OINT (LLUMC) [4080617]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 9994080617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.73
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Riverside University Health System MISP |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
BUTT PASTE OINT (LLUMC) [4080617]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 9994080617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.03
|
| Rate for Payer: Blue Shield of California EPN |
$7.56
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT [192162]
|
Facility
|
IP
|
$5,330.96
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,066.19 |
| Max. Negotiated Rate |
$4,797.86 |
| Rate for Payer: Adventist Health Commercial |
$1,066.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4,275.43
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.80
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Central Health Plan Commercial |
$4,264.77
|
| Rate for Payer: Cigna of CA HMO |
$3,731.67
|
| Rate for Payer: Cigna of CA PPO |
$3,731.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,731.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,132.38
|
| Rate for Payer: EPIC Health Plan Senior |
$2,132.38
|
| Rate for Payer: Galaxy Health WC |
$4,531.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3,198.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,797.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,385.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,066.19
|
| Rate for Payer: Multiplan Commercial |
$3,998.22
|
| Rate for Payer: Networks By Design Commercial |
$2,665.48
|
| Rate for Payer: Prime Health Services Commercial |
$4,531.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.71
|
| Rate for Payer: United Healthcare All Other HMO |
$1,947.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,905.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,745.89
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT [192162]
|
Facility
|
OP
|
$5,330.96
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$4,797.86 |
| Rate for Payer: Adventist Health Commercial |
$1,066.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$79.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.16
|
| Rate for Payer: Blue Shield of California Commercial |
$107.40
|
| Rate for Payer: Blue Shield of California EPN |
$97.64
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Central Health Plan Commercial |
$4,264.77
|
| Rate for Payer: Cigna of CA HMO |
$3,731.67
|
| Rate for Payer: Cigna of CA PPO |
$3,731.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,731.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.78
|
| Rate for Payer: EPIC Health Plan Senior |
$87.19
|
| Rate for Payer: Galaxy Health WC |
$4,531.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3,198.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,797.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$129.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,385.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,066.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$106.21
|
| Rate for Payer: Multiplan Commercial |
$3,998.22
|
| Rate for Payer: Networks By Design Commercial |
$2,665.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$79.26
|
| Rate for Payer: Prime Health Services Commercial |
$4,531.32
|
| Rate for Payer: Prime Health Services Medicare |
$84.02
|
| Rate for Payer: Riverside University Health System MISP |
$87.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,198.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,198.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.71
|
| Rate for Payer: United Healthcare All Other HMO |
$1,947.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,905.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,745.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$79.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.19
|
| Rate for Payer: Vantage Medical Group Senior |
$87.19
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION [196347]
|
Facility
|
IP
|
$5,330.96
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,066.19 |
| Max. Negotiated Rate |
$4,797.86 |
| Rate for Payer: Adventist Health Commercial |
$1,066.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4,275.43
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.80
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Central Health Plan Commercial |
$4,264.77
|
| Rate for Payer: Cigna of CA HMO |
$3,731.67
|
| Rate for Payer: Cigna of CA PPO |
$3,731.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,731.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,132.38
|
| Rate for Payer: EPIC Health Plan Senior |
$2,132.38
|
| Rate for Payer: Galaxy Health WC |
$4,531.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3,198.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,797.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,385.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,066.19
|
| Rate for Payer: Multiplan Commercial |
$3,998.22
|
| Rate for Payer: Networks By Design Commercial |
$2,665.48
|
| Rate for Payer: Prime Health Services Commercial |
$4,531.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.71
|
| Rate for Payer: United Healthcare All Other HMO |
$1,947.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,905.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,745.89
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION [196347]
|
Facility
|
OP
|
$5,330.96
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$4,797.86 |
| Rate for Payer: Adventist Health Commercial |
$1,066.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$79.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.16
|
| Rate for Payer: Blue Shield of California Commercial |
$107.40
|
| Rate for Payer: Blue Shield of California EPN |
$97.64
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Cash Price |
$2,398.93
|
| Rate for Payer: Central Health Plan Commercial |
$4,264.77
|
| Rate for Payer: Cigna of CA HMO |
$3,731.67
|
| Rate for Payer: Cigna of CA PPO |
$3,731.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,731.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.78
|
| Rate for Payer: EPIC Health Plan Senior |
$87.19
|
| Rate for Payer: Galaxy Health WC |
$4,531.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3,198.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,797.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$129.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,385.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,066.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$106.21
|
| Rate for Payer: Multiplan Commercial |
$3,998.22
|
| Rate for Payer: Networks By Design Commercial |
$2,665.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$79.26
|
| Rate for Payer: Prime Health Services Commercial |
$4,531.32
|
| Rate for Payer: Prime Health Services Medicare |
$84.02
|
| Rate for Payer: Riverside University Health System MISP |
$87.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,198.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,198.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.71
|
| Rate for Payer: United Healthcare All Other HMO |
$1,947.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,905.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,745.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$79.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.19
|
| Rate for Payer: Vantage Medical Group Senior |
$87.19
|
|
|
C1 ESTERASE INHIBITOR, RECOMBINANT 2,100 UNIT INTRAVENOUS SOLUTION [207371]
|
Facility
|
IP
|
$9,984.00
|
|
|
Service Code
|
HCPCS J0596
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,996.80 |
| Max. Negotiated Rate |
$8,985.60 |
| Rate for Payer: Adventist Health Commercial |
$1,996.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,007.17
|
| Rate for Payer: Blue Shield of California EPN |
$5,031.94
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,987.20
|
| Rate for Payer: Cigna of CA HMO |
$6,988.80
|
| Rate for Payer: Cigna of CA PPO |
$6,988.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,993.60
|
| Rate for Payer: Galaxy Health WC |
$8,486.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,990.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,985.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,339.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,890.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,996.80
|
| Rate for Payer: Multiplan Commercial |
$7,488.00
|
| Rate for Payer: Networks By Design Commercial |
$4,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,647.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,568.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,269.76
|
|
|
C1 ESTERASE INHIBITOR, RECOMBINANT 2,100 UNIT INTRAVENOUS SOLUTION [207371]
|
Facility
|
OP
|
$9,984.00
|
|
|
Service Code
|
HCPCS J0596
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$8,985.60 |
| Rate for Payer: Adventist Health Commercial |
$1,996.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.19
|
| Rate for Payer: Blue Shield of California Commercial |
$47.93
|
| Rate for Payer: Blue Shield of California EPN |
$43.57
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Cash Price |
$4,492.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,987.20
|
| Rate for Payer: Cigna of CA HMO |
$6,988.80
|
| Rate for Payer: Cigna of CA PPO |
$6,988.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.42
|
| Rate for Payer: EPIC Health Plan Senior |
$41.61
|
| Rate for Payer: Galaxy Health WC |
$8,486.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,990.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,985.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,339.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,996.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.69
|
| Rate for Payer: Multiplan Commercial |
$7,488.00
|
| Rate for Payer: Networks By Design Commercial |
$4,992.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.83
|
| Rate for Payer: Prime Health Services Commercial |
$8,486.40
|
| Rate for Payer: Prime Health Services Medicare |
$40.10
|
| Rate for Payer: Riverside University Health System MISP |
$41.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,990.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,990.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,647.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,568.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,269.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.61
|
| Rate for Payer: Vantage Medical Group Senior |
$41.61
|
|
|
CABAZITAXEL 60 MG/1.5ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [105644]
|
Facility
|
OP
|
$11,775.88
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.73 |
| Max. Negotiated Rate |
$10,598.29 |
| Rate for Payer: Adventist Health Commercial |
$2,355.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$233.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,373.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$350.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.64
|
| Rate for Payer: Blue Shield of California Commercial |
$311.22
|
| Rate for Payer: Blue Shield of California EPN |
$282.93
|
| Rate for Payer: Cash Price |
$5,299.15
|
| Rate for Payer: Cash Price |
$5,299.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,420.70
|
| Rate for Payer: Cigna of CA HMO |
$8,243.12
|
| Rate for Payer: Cigna of CA PPO |
$8,243.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,243.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.65
|
| Rate for Payer: EPIC Health Plan Senior |
$257.10
|
| Rate for Payer: Galaxy Health WC |
$10,009.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,065.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,598.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$383.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$233.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,477.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$438.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,355.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$8,831.91
|
| Rate for Payer: Networks By Design Commercial |
$5,887.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$233.73
|
| Rate for Payer: Prime Health Services Commercial |
$10,009.50
|
| Rate for Payer: Prime Health Services Medicare |
$247.75
|
| Rate for Payer: Riverside University Health System MISP |
$257.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,065.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,065.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,419.49
|
| Rate for Payer: United Healthcare All Other HMO |
$4,301.73
|
| Rate for Payer: United Healthcare HMO Rider |
$4,208.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,856.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$233.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.10
|
| Rate for Payer: Vantage Medical Group Senior |
$257.10
|
|
|
CABAZITAXEL 60 MG/1.5ML (MUST BE DILUTED TO 10 MG/ML) INTRAVENOUS SOLN [105644]
|
Facility
|
IP
|
$11,775.88
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,355.18 |
| Max. Negotiated Rate |
$10,598.29 |
| Rate for Payer: Adventist Health Commercial |
$2,355.18
|
| Rate for Payer: Blue Shield of California Commercial |
$9,444.26
|
| Rate for Payer: Blue Shield of California EPN |
$5,935.04
|
| Rate for Payer: Cash Price |
$5,299.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,420.70
|
| Rate for Payer: Cigna of CA HMO |
$8,243.12
|
| Rate for Payer: Cigna of CA PPO |
$8,243.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,243.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,710.35
|
| Rate for Payer: EPIC Health Plan Senior |
$4,710.35
|
| Rate for Payer: Galaxy Health WC |
$10,009.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,065.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,598.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,477.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,947.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,355.18
|
| Rate for Payer: Multiplan Commercial |
$8,831.91
|
| Rate for Payer: Networks By Design Commercial |
$5,887.94
|
| Rate for Payer: Prime Health Services Commercial |
$10,009.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,419.49
|
| Rate for Payer: United Healthcare All Other HMO |
$4,301.73
|
| Rate for Payer: United Healthcare HMO Rider |
$4,208.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,856.60
|
|
|
CABERGOLINE 0.25 MG 1/2 TABLET [4081952]
|
Facility
|
OP
|
$5.59
|
|
|
Service Code
|
NDC 9994081952
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.47
|
| Rate for Payer: Cigna of CA HMO |
$3.91
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$4.19
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.75
|
| Rate for Payer: Riverside University Health System MISP |
$2.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
CABERGOLINE 0.25 MG 1/2 TABLET [4081952]
|
Facility
|
IP
|
$5.59
|
|
|
Service Code
|
NDC 9994081952
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.82
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.47
|
| Rate for Payer: Cigna of CA HMO |
$3.91
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.19
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.75
|
|
