|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$11.44
|
|
|
Service Code
|
NDC 0025-1520-34
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$8.58 |
| Rate for Payer: Adventist Health Commercial |
$2.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.86
|
| Rate for Payer: Cash Price |
$5.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.74
|
| Rate for Payer: Heritage Provider Network Senior |
$7.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$8.58
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 33342-156-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
NDC 60687-436-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.20
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 62332-141-31
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$1.45
|
|
|
Service Code
|
NDC 0904-6502-61
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.23
|
| Rate for Payer: Dignity Health Senior |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.90
|
| Rate for Payer: Heritage Provider Network Senior |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1.23
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 62332-141-31
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$1.23
|
|
|
Service Code
|
NDC 59762-1517-1
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Blue Shield of California Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.05
|
| Rate for Payer: Dignity Health Senior |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Senior |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$1.23
|
|
|
Service Code
|
NDC 59762-1517-1
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.85
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Senior |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$6.04
|
|
|
Service Code
|
NDC 51079-215-20
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.55
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.13
|
| Rate for Payer: Dignity Health Senior |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 62332-142-31
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$2.43
|
|
|
Service Code
|
NDC 60687-447-11
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.07
|
| Rate for Payer: Dignity Health Senior |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2.07
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$2.43
|
|
|
Service Code
|
NDC 60687-447-11
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.67
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| 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 Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 72241-024-05
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$18.76
|
|
|
Service Code
|
NDC 0025-1525-34
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.07
|
| Rate for Payer: Blue Shield of California Commercial |
$11.65
|
| Rate for Payer: Blue Shield of California EPN |
$11.01
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.95
|
| Rate for Payer: Dignity Health Senior |
$15.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.61
|
| Rate for Payer: Heritage Provider Network Senior |
$11.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$14.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Vantage Medical Group Senior |
$15.95
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$18.76
|
|
|
Service Code
|
NDC 0025-1525-34
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Adventist Health Commercial |
$3.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.89
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.70
|
| Rate for Payer: Heritage Provider Network Senior |
$12.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$14.07
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$6.04
|
|
|
Service Code
|
NDC 51079-215-01
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.55
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.13
|
| Rate for Payer: Dignity Health Senior |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$6.04
|
|
|
Service Code
|
NDC 51079-215-01
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.15
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.09
|
| Rate for Payer: Heritage Provider Network Senior |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 72241-024-05
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 62332-142-31
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Senior |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
CELECOXIB 200 MG CAPSULE [24501]
|
Facility
IP
|
$6.04
|
|
|
Service Code
|
NDC 51079-215-20
|
| Hospital Charge Code |
1710871
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.15
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.09
|
| Rate for Payer: Heritage Provider Network Senior |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
IP
|
$7,762.18
|
|
|
Service Code
|
APR-DRG 3833
|
| Min. Negotiated Rate |
$7,762.18 |
| Max. Negotiated Rate |
$7,762.18 |
| Rate for Payer: IEHP Medi-Cal |
$7,762.18
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
IP
|
$14,180.25
|
|
|
Service Code
|
APR-DRG 3834
|
| Min. Negotiated Rate |
$14,180.25 |
| Max. Negotiated Rate |
$14,180.25 |
| Rate for Payer: IEHP Medi-Cal |
$14,180.25
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
IP
|
$5,217.23
|
|
|
Service Code
|
APR-DRG 3832
|
| Min. Negotiated Rate |
$5,217.23 |
| Max. Negotiated Rate |
$5,217.23 |
| Rate for Payer: IEHP Medi-Cal |
$5,217.23
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
IP
|
$3,806.47
|
|
|
Service Code
|
APR-DRG 3831
|
| Min. Negotiated Rate |
$3,806.47 |
| Max. Negotiated Rate |
$3,806.47 |
| Rate for Payer: IEHP Medi-Cal |
$3,806.47
|
|
|
CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION [222941]
|
Facility
OP
|
$1,680.32
|
|
|
Service Code
|
CPT J9119
|
| Hospital Charge Code |
NDG222941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$1,260.24 |
| Rate for Payer: Adventist Health Commercial |
$336.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,154.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$28.01
|
| Rate for Payer: Cash Price |
$756.14
|
| Rate for Payer: Cash Price |
$756.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$772.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.21
|
| Rate for Payer: Dignity Health Senior |
$30.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$777.99
|
| Rate for Payer: Heritage Provider Network Senior |
$777.99
|
| Rate for Payer: Humana Medicare |
$27.46
|
| Rate for Payer: IEHP Medi-Cal |
$49.80
|
| Rate for Payer: IEHP Medicare Advantage |
$27.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$1,260.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.21
|
| Rate for Payer: TriValley Medical Group Senior |
$27.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$612.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$561.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.21
|
| Rate for Payer: Vantage Medical Group Senior |
$30.21
|
|
