|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]
|
Facility
IP
|
$22.01
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
ERX17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.07
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.67
|
| Rate for Payer: Heritage Provider Network Senior |
$4.67
|
| Rate for Payer: Heritage Provider Network Senior |
$16.82
|
| Rate for Payer: Heritage Provider Network Senior |
$14.90
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$16.51
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.31
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [17380]
|
Facility
OP
|
$22.01
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
ERX17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.12
|
| Rate for Payer: Dignity Health Senior |
$21.12
|
| Rate for Payer: Dignity Health Senior |
$30.60
|
| Rate for Payer: Dignity Health Senior |
$5.86
|
| Rate for Payer: Dignity Health Senior |
$18.71
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$11.51
|
| Rate for Payer: Heritage Provider Network Senior |
$3.19
|
| Rate for Payer: Heritage Provider Network Senior |
$16.67
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$10.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$16.51
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.71
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$18.71
|
| Rate for Payer: Vantage Medical Group Senior |
$21.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.86
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
1753510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$2.47
|
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.49
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.45
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$7.45
|
| Rate for Payer: Heritage Provider Network Senior |
$8.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.75
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$9.27
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.68
|
|
|
MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
CPT J2185
|
| Hospital Charge Code |
1753510
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$10.25 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$2.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.51
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$10.51
|
| Rate for Payer: Dignity Health Senior |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.72
|
| Rate for Payer: Heritage Provider Network Senior |
$5.09
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.51
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.51
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]
|
Facility
OP
|
$259.20
|
|
|
Service Code
|
CPT J2186
|
| Hospital Charge Code |
ERX219863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Adventist Health Commercial |
$51.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.28
|
| Rate for Payer: Dignity Health Senior |
$2.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.01
|
| Rate for Payer: Heritage Provider Network Senior |
$120.01
|
| Rate for Payer: Humana Medicare |
$2.08
|
| Rate for Payer: IEHP Medi-Cal |
$10.33
|
| Rate for Payer: IEHP Medicare Advantage |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.28
|
| Rate for Payer: TriValley Medical Group Senior |
$2.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$86.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: Vantage Medical Group Senior |
$2.08
|
|
|
MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION [219863]
|
Facility
IP
|
$259.20
|
|
|
Service Code
|
CPT J2186
|
| Hospital Charge Code |
ERX219863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Adventist Health Commercial |
$51.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.07
|
| Rate for Payer: Cash Price |
$116.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.48
|
| Rate for Payer: Heritage Provider Network Senior |
$175.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$86.60
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$19.10
|
|
|
Service Code
|
NDC 0378-9230-93
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Blue Shield of California Commercial |
$11.86
|
| Rate for Payer: Blue Shield of California EPN |
$11.21
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.24
|
| Rate for Payer: Dignity Health Senior |
$16.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.82
|
| Rate for Payer: Heritage Provider Network Senior |
$11.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.24
|
| Rate for Payer: Vantage Medical Group Senior |
$16.24
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-6
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.26
|
| Rate for Payer: Blue Shield of California Commercial |
$4.36
|
| Rate for Payer: Blue Shield of California EPN |
$4.12
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.97
|
| Rate for Payer: Dignity Health Senior |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.35
|
| Rate for Payer: Heritage Provider Network Senior |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Vantage Medical Group Senior |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-7
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.26
|
| Rate for Payer: Blue Shield of California Commercial |
$4.36
|
| Rate for Payer: Blue Shield of California EPN |
$4.12
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.97
|
| Rate for Payer: Dignity Health Senior |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.35
|
| Rate for Payer: Heritage Provider Network Senior |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Vantage Medical Group Senior |
$5.97
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$6.77
|
|
|
Service Code
|
NDC 59762-0118-3
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.65
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.58
|
| Rate for Payer: Heritage Provider Network Senior |
$4.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$5.08
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$19.10
|
|
|
Service Code
|
NDC 0378-9230-93
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.12
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.93
|
| Rate for Payer: Heritage Provider Network Senior |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-7
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.82
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
IP
|
$7.02
|
|
|
Service Code
|
NDC 70710-1302-6
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.82
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
|
|
MESALAMINE 1,000 MG RECTAL SUPPOSITORY [40369]
|
Facility
OP
|
$6.77
|
|
|
Service Code
|
NDC 59762-0118-3
|
| Hospital Charge Code |
1748087
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.75
|
| Rate for Payer: Dignity Health Senior |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| 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 Commercial |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$5.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5.75
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-25
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.36
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$7.33
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.61
|
| Rate for Payer: Dignity Health Senior |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.73
|
| Rate for Payer: Heritage Provider Network Senior |
$7.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$9.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.61
|
| Rate for Payer: Vantage Medical Group Senior |
$10.61
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$11.23
|
|
|
Service Code
|
NDC 54092-476-12
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$6.59
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Senior |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-95
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.36
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$7.33
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.61
|
| Rate for Payer: Dignity Health Senior |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.73
|
| Rate for Payer: Heritage Provider Network Senior |
$7.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$9.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.61
|
| Rate for Payer: Vantage Medical Group Senior |
$10.61
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-25
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.57
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Senior |
$8.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$9.36
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$2.67
|
|
|
Service Code
|
NDC 0378-7401-78
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.27
|
| Rate for Payer: Dignity Health Senior |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$11.23
|
|
|
Service Code
|
NDC 54092-476-12
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$2.67
|
|
|
Service Code
|
NDC 0378-7401-78
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.83
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$12.48
|
|
|
Service Code
|
NDC 60687-397-95
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.57
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Senior |
$8.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$9.36
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
OP
|
$5.34
|
|
|
Service Code
|
NDC 63304-175-13
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California EPN |
$3.13
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.54
|
| Rate for Payer: Dignity Health Senior |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.31
|
| Rate for Payer: Heritage Provider Network Senior |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: Vantage Medical Group Senior |
$4.54
|
|
|
MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]
|
Facility
IP
|
$5.34
|
|
|
Service Code
|
NDC 63304-175-13
|
| Hospital Charge Code |
1712343
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.67
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
|
|
MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE) [214804]
|
Facility
IP
|
$4.66
|
|
|
Service Code
|
NDC 0023-5853-18
|
| Hospital Charge Code |
ERX214804
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Adventist Health Commercial |
$0.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.20
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.15
|
| Rate for Payer: Heritage Provider Network Senior |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$3.50
|
|
