|
MVI ADULT WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION. [40810661]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 54643-5650-2
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
|
|
MVI ADULT WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION. [40810661]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
NDC 54643-5649-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
|
|
MVI ADULT WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION. [40810661]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
NDC 54643-5649-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.57
|
| Rate for Payer: Dignity Health Senior |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.57
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN [117200]
|
Facility
|
IP
|
$5.77
|
|
|
Service Code
|
NDC 54643-5646-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.91
|
| Rate for Payer: Heritage Provider Network Senior |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.33
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN [117200]
|
Facility
|
OP
|
$5.77
|
|
|
Service Code
|
NDC 54643-5646-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.82
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.90
|
| Rate for Payer: Dignity Health Senior |
$4.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.57
|
| Rate for Payer: Heritage Provider Network Senior |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$4.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4.90
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN [117200]
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
NDC 54643-5647-0
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.99
|
| Rate for Payer: Heritage Provider Network Senior |
$3.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN [117200]
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
NDC 54643-5647-0
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Senior |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.36
|
| Rate for Payer: TriValley Medical Group Senior |
$2.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION [23968]
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Adventist Health Commercial |
$25.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$69.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$71.27
|
| Rate for Payer: Cash Price |
$71.27
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.95
|
| Rate for Payer: Dignity Health Senior |
$110.13
|
| Rate for Payer: Dignity Health Senior |
$73.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.99
|
| Rate for Payer: Heritage Provider Network Senior |
$59.99
|
| Rate for Payer: Heritage Provider Network Senior |
$40.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.90
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$97.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.83
|
| Rate for Payer: TriValley Medical Group Senior |
$51.83
|
| Rate for Payer: TriValley Medical Group Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$110.13
|
| Rate for Payer: Vantage Medical Group Senior |
$73.95
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION [23968]
|
Facility
|
IP
|
$129.57
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$97.18 |
| Rate for Payer: Adventist Health Commercial |
$25.91
|
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$71.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.99
|
| Rate for Payer: Heritage Provider Network Senior |
$59.99
|
| Rate for Payer: Heritage Provider Network Senior |
$40.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.39
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$97.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.90
|
|
|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION [25005]
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.88
|
| Rate for Payer: Dignity Health Senior |
$0.94
|
| Rate for Payer: Dignity Health Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$2.88
|
|
|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION [25005]
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.37
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Senior |
$0.66
|
| Rate for Payer: Dignity Health Senior |
$0.65
|
| Rate for Payer: Dignity Health Senior |
$0.47
|
| Rate for Payer: Dignity Health Senior |
$0.56
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.26
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]
|
Facility
|
IP
|
$0.98
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.32
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Senior |
$1.12
|
| Rate for Payer: Dignity Health Senior |
$0.41
|
| Rate for Payer: Dignity Health Senior |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Senior |
$0.19
|
| Rate for Payer: TriValley Medical Group Senior |
$0.53
|
| Rate for Payer: TriValley Medical Group Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.61
|
| Rate for Payer: Dignity Health Senior |
$7.61
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: Dignity Health Senior |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$3.35
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$3.58
|
| Rate for Payer: TriValley Medical Group Senior |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7.61
|
| Rate for Payer: Vantage Medical Group Senior |
$3.80
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$4.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$3.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.48
|
|
|
MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE [38063]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
|
|
MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE [38063]
|
Facility
|
OP
|
$9.13
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.76
|
| Rate for Payer: Dignity Health Senior |
$0.37
|
| Rate for Payer: Dignity Health Senior |
$7.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$4.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.39
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Senior |
$0.18
|
| Rate for Payer: TriValley Medical Group Senior |
$3.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.76
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$7.76
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
IP
|
$6.19
|
|
|
Service Code
|
NDC 51079-812-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.19
|
| Rate for Payer: Heritage Provider Network Senior |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$4.64
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
OP
|
$6.19
|
|
|
Service Code
|
NDC 51079-812-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.02
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.26
|
| Rate for Payer: Dignity Health Senior |
$5.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.83
|
| Rate for Payer: Heritage Provider Network Senior |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$4.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Senior |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.26
|
| Rate for Payer: Vantage Medical Group Senior |
$5.26
|
|
|
NADOLOL 40 MG TABLET [5331]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 69097-868-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
NADOLOL 40 MG TABLET [5331]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 69097-868-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
NADOLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080308]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 9994-0803-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Senior |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
NADOLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080308]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 9994-0803-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
