|
CINACALCET 30 MG TABLET [38100]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 69097-410-02
|
| Hospital Charge Code |
1710945
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Senior |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
NDC 67877-503-30
|
| Hospital Charge Code |
1710945
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 16729-440-10
|
| Hospital Charge Code |
1710945
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 69097-410-02
|
| Hospital Charge Code |
1710945
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
CINACALCET 30 MG TABLET [38100]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
NDC 67877-503-30
|
| Hospital Charge Code |
1710945
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Senior |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
NDC 69097-411-02
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Senior |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
NDC 67877-504-30
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.73
|
| Rate for Payer: Heritage Provider Network Senior |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
NDC 65862-832-30
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Senior |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
IP
|
$64.54
|
|
|
Service Code
|
NDC 55513-074-30
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Adventist Health Commercial |
$12.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.34
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.69
|
| Rate for Payer: Heritage Provider Network Senior |
$43.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.14
|
| Rate for Payer: Multiplan Commercial |
$48.40
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
NDC 16729-441-10
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Senior |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
NDC 65862-832-30
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.73
|
| Rate for Payer: Heritage Provider Network Senior |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
NDC 16729-441-10
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.73
|
| Rate for Payer: Heritage Provider Network Senior |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
OP
|
$1.08
|
|
|
Service Code
|
NDC 67877-504-30
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Senior |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
OP
|
$64.54
|
|
|
Service Code
|
NDC 55513-074-30
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$54.86 |
| Rate for Payer: Adventist Health Commercial |
$12.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$54.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.40
|
| Rate for Payer: Blue Shield of California Commercial |
$40.08
|
| Rate for Payer: Blue Shield of California EPN |
$37.88
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Senior |
$54.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.95
|
| Rate for Payer: Heritage Provider Network Senior |
$39.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.14
|
| Rate for Payer: Multiplan Commercial |
$48.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$54.86
|
|
|
CINACALCET 60 MG TABLET [38101]
|
Facility
IP
|
$1.08
|
|
|
Service Code
|
NDC 69097-411-02
|
| Hospital Charge Code |
1710946
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.73
|
| Rate for Payer: Heritage Provider Network Senior |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
|
|
CINACALCET 90 MG TABLET [38102]
|
Facility
IP
|
$96.80
|
|
|
Service Code
|
NDC 55513-075-30
|
| Hospital Charge Code |
1712405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Adventist Health Commercial |
$19.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.50
|
| Rate for Payer: Cash Price |
$43.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.53
|
| Rate for Payer: Heritage Provider Network Senior |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$72.60
|
|
|
CINACALCET 90 MG TABLET [38102]
|
Facility
OP
|
$96.80
|
|
|
Service Code
|
NDC 55513-075-30
|
| Hospital Charge Code |
1712405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Adventist Health Commercial |
$19.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$82.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$72.60
|
| Rate for Payer: Blue Shield of California Commercial |
$60.11
|
| Rate for Payer: Blue Shield of California EPN |
$56.82
|
| Rate for Payer: Cash Price |
$43.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.28
|
| Rate for Payer: Dignity Health Senior |
$82.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.92
|
| Rate for Payer: Heritage Provider Network Senior |
$59.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$72.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.28
|
| Rate for Payer: Vantage Medical Group Senior |
$82.28
|
|
|
CIPROFLOXACIN 0.2 %-HYDROCORTISONE 1 % EAR DROPS,SUSPENSION [22986]
|
Facility
IP
|
$37.90
|
|
|
Service Code
|
NDC 0065-8531-10
|
| Hospital Charge Code |
1740308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$28.42 |
| Rate for Payer: Adventist Health Commercial |
$7.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.04
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.66
|
| Rate for Payer: Heritage Provider Network Senior |
$25.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.48
|
| Rate for Payer: Multiplan Commercial |
$28.42
|
|
|
CIPROFLOXACIN 0.2 %-HYDROCORTISONE 1 % EAR DROPS,SUSPENSION [22986]
|
Facility
OP
|
$37.90
|
|
|
Service Code
|
NDC 0065-8531-10
|
| Hospital Charge Code |
1740308
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$32.22 |
| Rate for Payer: Adventist Health Commercial |
$7.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.42
|
| Rate for Payer: Blue Shield of California Commercial |
$23.54
|
| Rate for Payer: Blue Shield of California EPN |
$22.25
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.22
|
| Rate for Payer: Dignity Health Senior |
$32.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.46
|
| Rate for Payer: Heritage Provider Network Senior |
$23.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.48
|
| Rate for Payer: Multiplan Commercial |
$28.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.22
|
| Rate for Payer: Vantage Medical Group Senior |
$32.22
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
NDC 43598-326-75
|
| Hospital Charge Code |
1740331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.00
|
| Rate for Payer: Blue Shield of California Commercial |
$17.39
|
| Rate for Payer: Blue Shield of California EPN |
$16.44
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.80
|
| Rate for Payer: Dignity Health Senior |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23.80
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
NDC 43598-326-75
|
| Hospital Charge Code |
1740331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
OP
|
$5.04
|
|
|
Service Code
|
NDC 61314-656-25
|
| Hospital Charge Code |
1740265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.96
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Senior |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
NDC 61314-656-05
|
| Hospital Charge Code |
1740266
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.31
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
IP
|
$5.04
|
|
|
Service Code
|
NDC 61314-656-25
|
| Hospital Charge Code |
1740265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.46
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
|
|
CIPROFLOXACIN 0.3 % EYE DROPS [9610]
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
NDC 61314-656-05
|
| Hospital Charge Code |
1740266
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: Dignity Health Senior |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
