|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
IP
|
$6.34
|
|
|
Service Code
|
CPT J0595
|
| Hospital Charge Code |
1720575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| 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 |
$4.76
|
| Rate for Payer: Blue Shield of California EPN |
$3.39
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Central Health Plan Commercial |
$5.07
|
| Rate for Payer: Cigna of CA HMO |
$4.44
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.39
|
| Rate for Payer: Global Benefits Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.76
|
| Rate for Payer: Networks By Design Commercial |
$3.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.39
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
OP
|
$6.34
|
|
|
Service Code
|
CPT J0595
|
| Hospital Charge Code |
1720575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.22
|
| Rate for Payer: BCBS Transplant Transplant |
$3.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.93
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Central Health Plan Commercial |
$5.07
|
| Rate for Payer: Cigna of CA HMO |
$4.44
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.39
|
| Rate for Payer: Global Benefits Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.76
|
| Rate for Payer: IEHP medi-cal |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.76
|
| Rate for Payer: Networks By Design Commercial |
$3.17
|
| Rate for Payer: Prime Health Services Commercial |
$5.39
|
| Rate for Payer: Riverside University Health MISP |
$2.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.39
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
BUTORPHANOL 2 MG/ML INJECTION SOLUTION [9334]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J0595
|
| Hospital Charge Code |
1720351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.22
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.93
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| 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: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: IEHP medi-cal |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Riverside University Health MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
BUTT PASTE OINT (LLUMC) [4080617]
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
NDC 9994-0806-17
|
| Hospital Charge Code |
1743709
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.86
|
| Rate for Payer: BCBS Transplant Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.44
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| 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: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: IEHP medi-cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: Riverside University Health 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 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 9994-0806-17
|
| Hospital Charge Code |
1743709
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| 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 |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$8.01
|
| Rate for Payer: Cash Price |
$6.75
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$10.00
|
| 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
|
$4,344.83
|
|
|
Service Code
|
CPT J0597
|
| Hospital Charge Code |
ERX192145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$868.97 |
| 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 |
$3,258.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,320.14
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Central Health Plan Commercial |
$3,475.86
|
| Rate for Payer: Cigna of CA HMO |
$3,041.38
|
| Rate for Payer: Cigna of CA PPO |
$3,041.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,737.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,737.93
|
| Rate for Payer: Galaxy Health WC |
$3,693.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2,606.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,910.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,898.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.97
|
| Rate for Payer: Multiplan Commercial |
$3,258.62
|
| Rate for Payer: Networks By Design Commercial |
$2,172.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,693.11
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT [192162]
|
Facility
OP
|
$4,344.83
|
|
|
Service Code
|
CPT J0597
|
| Hospital Charge Code |
ERX192145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.36 |
| Max. Negotiated Rate |
$3,910.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$64.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$398.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$80.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.72
|
| Rate for Payer: BCBS Transplant Transplant |
$2,606.90
|
| Rate for Payer: Blue Shield of California Commercial |
$81.84
|
| Rate for Payer: Blue Shield of California EPN |
$74.40
|
| Rate for Payer: Caremore Medicare Advantage |
$64.36
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Central Health Plan Commercial |
$3,475.86
|
| Rate for Payer: Cigna of CA HMO |
$3,041.38
|
| Rate for Payer: Cigna of CA PPO |
$3,041.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$64.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.36
|
| Rate for Payer: Galaxy Health WC |
$3,693.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2,606.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,910.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,258.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$105.54
|
| Rate for Payer: IEHP medi-cal |
$106.19
|
| Rate for Payer: IEHP Medicare Advantage |
$64.36
|
| Rate for Payer: Innovage PACE Commercial |
$96.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,898.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.24
|
| Rate for Payer: Multiplan Commercial |
$3,258.62
|
| Rate for Payer: Networks By Design Commercial |
$2,172.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,693.11
|
| Rate for Payer: Prime Health Services Medicare |
$68.22
|
| Rate for Payer: Riverside University Health MISP |
$70.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,606.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,606.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,172.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,172.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,172.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.79
|
| Rate for Payer: Vantage Medical Group Senior |
$64.36
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION [196347]
|
Facility
OP
|
$4,344.83
|
|
|
Service Code
|
CPT J0597
|
| Hospital Charge Code |
ERX196347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.36 |
| Max. Negotiated Rate |
$3,910.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$64.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$398.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$80.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.72
|
| Rate for Payer: BCBS Transplant Transplant |
$2,606.90
|
| Rate for Payer: Blue Shield of California Commercial |
$81.84
|
| Rate for Payer: Blue Shield of California EPN |
$74.40
|
| Rate for Payer: Caremore Medicare Advantage |
$64.36
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Central Health Plan Commercial |
$3,475.86
|
| Rate for Payer: Cigna of CA HMO |
$3,041.38
|
| Rate for Payer: Cigna of CA PPO |
$3,041.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$64.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.36
|
| Rate for Payer: Galaxy Health WC |
$3,693.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2,606.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,910.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,258.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$105.54
|
| Rate for Payer: IEHP medi-cal |
$106.19
|
| Rate for Payer: IEHP Medicare Advantage |
$64.36
|
| Rate for Payer: Innovage PACE Commercial |
$96.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,898.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.24
|
| Rate for Payer: Multiplan Commercial |
$3,258.62
|
| Rate for Payer: Networks By Design Commercial |
$2,172.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,693.11
|
| Rate for Payer: Prime Health Services Medicare |
$68.22
|
| Rate for Payer: Riverside University Health MISP |
$70.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,606.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,606.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,172.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,172.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,172.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,172.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.79
|
| Rate for Payer: Vantage Medical Group Senior |
$64.36
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION [196347]
|
Facility
IP
|
$4,344.83
|
|
|
Service Code
|
CPT J0597
|
| Hospital Charge Code |
ERX196347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$868.97 |
| 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 |
$3,258.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,320.14
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Cash Price |
$1,955.17
|
| Rate for Payer: Central Health Plan Commercial |
$3,475.86
|
| Rate for Payer: Cigna of CA HMO |
$3,041.38
|
| Rate for Payer: Cigna of CA PPO |
$3,041.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,737.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,737.93
|
| Rate for Payer: Galaxy Health WC |
$3,693.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2,606.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,910.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,898.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.97
|
| Rate for Payer: Multiplan Commercial |
$3,258.62
|
| Rate for Payer: Networks By Design Commercial |
$2,172.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,693.11
|
|
|
C1 ESTERASE INHIBITOR, RECOMBINANT 2,100 UNIT INTRAVENOUS SOLUTION [207371]
|
Facility
OP
|
$8,724.00
|
|
|
Service Code
|
CPT J0596
|
| Hospital Charge Code |
ERX207371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.51 |
| Max. Negotiated Rate |
$7,851.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$33.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.32
|
| Rate for Payer: BCBS Transplant Transplant |
$5,234.40
|
| Rate for Payer: Blue Shield of California Commercial |
$39.18
|
| Rate for Payer: Blue Shield of California EPN |
$35.62
|
| Rate for Payer: Caremore Medicare Advantage |
$33.51
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,979.20
|
| Rate for Payer: Cigna of CA HMO |
$6,106.80
|
| Rate for Payer: Cigna of CA PPO |
$6,106.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.51
|
| Rate for Payer: Galaxy Health WC |
$7,415.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,234.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,851.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,543.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$54.95
|
| Rate for Payer: IEHP medi-cal |
$55.29
|
| Rate for Payer: IEHP Medicare Advantage |
$33.51
|
| Rate for Payer: Innovage PACE Commercial |
$50.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,818.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,744.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.90
|
| Rate for Payer: Multiplan Commercial |
$6,543.00
|
| Rate for Payer: Networks By Design Commercial |
$4,362.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,415.40
|
| Rate for Payer: Prime Health Services Medicare |
$35.52
|
| Rate for Payer: Riverside University Health MISP |
$36.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,234.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,234.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,362.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,362.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,362.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,362.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.86
|
| Rate for Payer: Vantage Medical Group Senior |
$33.51
|
|
|
C1 ESTERASE INHIBITOR, RECOMBINANT 2,100 UNIT INTRAVENOUS SOLUTION [207371]
|
Facility
IP
|
$8,724.00
|
|
|
Service Code
|
CPT J0596
|
| Hospital Charge Code |
ERX207371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,744.80 |
| 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 |
$6,543.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,658.62
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,979.20
|
| Rate for Payer: Cigna of CA HMO |
$6,106.80
|
| Rate for Payer: Cigna of CA PPO |
$6,106.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,489.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,489.60
|
| Rate for Payer: Galaxy Health WC |
$7,415.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,234.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,851.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,818.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,744.80
|
| Rate for Payer: Multiplan Commercial |
$6,543.00
|
| Rate for Payer: Networks By Design Commercial |
$4,362.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,415.40
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION [105644]
|
Facility
IP
|
$10,772.15
|
|
|
Service Code
|
CPT J9043
|
| Hospital Charge Code |
1755729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,154.43 |
| 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 |
$8,079.11
|
| Rate for Payer: Blue Shield of California EPN |
$5,752.33
|
| Rate for Payer: Cash Price |
$4,847.47
|
| Rate for Payer: Cash Price |
$4,847.47
|
| Rate for Payer: Central Health Plan Commercial |
$8,617.72
|
| Rate for Payer: Cigna of CA HMO |
$7,540.50
|
| Rate for Payer: Cigna of CA PPO |
$7,540.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,308.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,308.86
|
| Rate for Payer: Galaxy Health WC |
$9,156.33
|
| Rate for Payer: Global Benefits Group Commercial |
$6,463.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,694.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,185.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,154.43
|
| Rate for Payer: Multiplan Commercial |
$8,079.11
|
| Rate for Payer: Networks By Design Commercial |
$5,386.08
|
| Rate for Payer: Prime Health Services Commercial |
$9,156.33
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION [105644]
|
Facility
OP
|
$10,772.15
|
|
|
Service Code
|
CPT J9043
|
| Hospital Charge Code |
1755729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.45 |
| Max. Negotiated Rate |
$9,694.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$210.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,304.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$263.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.85
|
| Rate for Payer: BCBS Transplant Transplant |
$6,463.29
|
| Rate for Payer: Blue Shield of California Commercial |
$253.91
|
| Rate for Payer: Blue Shield of California EPN |
$230.83
|
| Rate for Payer: Caremore Medicare Advantage |
$210.45
|
| Rate for Payer: Cash Price |
$4,847.47
|
| Rate for Payer: Cash Price |
$4,847.47
|
| Rate for Payer: Central Health Plan Commercial |
$8,617.72
|
| Rate for Payer: Cigna of CA HMO |
$7,540.50
|
| Rate for Payer: Cigna of CA PPO |
$7,540.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.45
|
| Rate for Payer: Galaxy Health WC |
$9,156.33
|
| Rate for Payer: Global Benefits Group Commercial |
$6,463.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,694.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,079.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$345.14
|
| Rate for Payer: IEHP medi-cal |
$347.25
|
| Rate for Payer: IEHP Medicare Advantage |
$210.45
|
| Rate for Payer: Innovage PACE Commercial |
$315.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,185.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,154.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$282.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.01
|
| Rate for Payer: Multiplan Commercial |
$8,079.11
|
| Rate for Payer: Networks By Design Commercial |
$5,386.08
|
| Rate for Payer: Prime Health Services Commercial |
$9,156.33
|
| Rate for Payer: Prime Health Services Medicare |
$223.08
|
| Rate for Payer: Riverside University Health MISP |
$231.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,463.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,463.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,386.08
|
| Rate for Payer: United Healthcare All Other HMO |
$5,386.08
|
| Rate for Payer: United Healthcare HMO Rider |
$5,386.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,386.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$315.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.50
|
| Rate for Payer: Vantage Medical Group Senior |
$210.45
|
|
|
CABERGOLINE 0.25 MG 1/2 TABLET [4081952]
|
Facility
IP
|
$5.59
|
|
|
Service Code
|
NDC 9994-0819-52
|
| Hospital Charge Code |
ERX4081952
|
|
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 |
$4.19
|
| 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 |
$4.47
|
| 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 |
$2.24
|
| 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 Permanente of CA Commercial/Self Funded |
$3.73
|
| 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
|
|
|
CABERGOLINE 0.25 MG 1/2 TABLET [4081952]
|
Facility
OP
|
$5.59
|
|
|
Service Code
|
NDC 9994-0819-52
|
| Hospital Charge Code |
ERX4081952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.30
|
| Rate for Payer: BCBS Transplant Transplant |
$3.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| 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: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$4.19
|
| Rate for Payer: IEHP medi-cal |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.73
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: Riverside University Health 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 |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
IP
|
$2.44
|
|
|
Service Code
|
NDC 23155-823-73
|
| Hospital Charge Code |
1712340
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| 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 |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.30
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Central Health Plan Commercial |
$1.95
|
| Rate for Payer: Cigna of CA HMO |
$1.71
|
| Rate for Payer: Cigna of CA PPO |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.83
|
| Rate for Payer: Networks By Design Commercial |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.07
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
OP
|
$2.44
|
|
|
Service Code
|
NDC 23155-823-73
|
| Hospital Charge Code |
1712340
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Central Health Plan Commercial |
$1.95
|
| Rate for Payer: Cigna of CA HMO |
$1.71
|
| Rate for Payer: Cigna of CA PPO |
$1.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.83
|
| Rate for Payer: IEHP medi-cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.83
|
| Rate for Payer: Networks By Design Commercial |
$1.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.46
|
| Rate for Payer: Riverside University Health MISP |
$0.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2.07
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
OP
|
$3.75
|
|
|
Service Code
|
NDC 50742-118-08
|
| Hospital Charge Code |
1712340
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.22
|
| Rate for Payer: BCBS Transplant Transplant |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Central Health Plan Commercial |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$2.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$3.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.81
|
| Rate for Payer: IEHP medi-cal |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.25
|
| Rate for Payer: Riverside University Health MISP |
$1.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.19
|
| Rate for Payer: Vantage Medical Group Senior |
$3.19
|
|
|
CABERGOLINE 0.5 MG TABLET [19226]
|
Facility
IP
|
$3.75
|
|
|
Service Code
|
NDC 50742-118-08
|
| Hospital Charge Code |
1712340
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| 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 |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Central Health Plan Commercial |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$3.19
|
| Rate for Payer: Global Benefits Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.81
|
| Rate for Payer: Networks By Design Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$3.19
|
|
|
CADEXOMER IODINE 0.9 % TOPICAL GEL [12858]
|
Facility
OP
|
$3.40
|
|
|
Service Code
|
NDC 4056512249
|
| Hospital Charge Code |
1743674
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.01
|
| Rate for Payer: BCBS Transplant Transplant |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Central Health Plan Commercial |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$2.38
|
| Rate for Payer: Cigna of CA PPO |
$2.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.55
|
| Rate for Payer: IEHP medi-cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.55
|
| Rate for Payer: Networks By Design Commercial |
$2.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.04
|
| Rate for Payer: Riverside University Health MISP |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Vantage Medical Group Senior |
$2.89
|
|
|
CADEXOMER IODINE 0.9 % TOPICAL GEL [12858]
|
Facility
IP
|
$3.40
|
|
|
Service Code
|
NDC 4056512249
|
| Hospital Charge Code |
1743674
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| 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 |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Central Health Plan Commercial |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$2.38
|
| Rate for Payer: Cigna of CA PPO |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$2.89
|
| Rate for Payer: Global Benefits Group Commercial |
$2.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.55
|
| Rate for Payer: Networks By Design Commercial |
$2.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.89
|
|
|
CAFFEINE 200 MG TABLET [1259]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 4601701816
|
| Hospital Charge Code |
1710902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
CAFFEINE 200 MG TABLET [1259]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 4601701840
|
| Hospital Charge Code |
1710902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
CAFFEINE 200 MG TABLET [1259]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 4601701840
|
| Hospital Charge Code |
1710902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| 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 |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
CAFFEINE 200 MG TABLET [1259]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 4601701816
|
| Hospital Charge Code |
1710902
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| 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 |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
