|
8E023DZ
|
Facility
|
IP
|
$10,777.00
|
|
| Hospital Charge Code |
2774
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
8E0W4CZ
|
Facility
|
IP
|
$11,114.00
|
|
| Hospital Charge Code |
5385
|
| Min. Negotiated Rate |
$11,114.00 |
| Max. Negotiated Rate |
$11,114.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,114.00
|
|
|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
IP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
|
|
ABACAVIR 20 MG/ML ORAL SOLUTION [24439]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 31722-562-24
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Senior |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
IP
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.17
|
| Rate for Payer: Heritage Provider Network Senior |
$7.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$7.94
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
OP
|
$10.59
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.94
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$5.17
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.00
|
| Rate for Payer: Dignity Health Senior |
$9.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$7.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.24
|
| Rate for Payer: TriValley Medical Group Senior |
$4.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.00
|
|
|
ABACAVIR 300 MG TABLET [24438]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 31722-557-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Senior |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
IP
|
$155.90
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$116.92 |
| Rate for Payer: Adventist Health Commercial |
$31.18
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.54
|
| Rate for Payer: Heritage Provider Network Senior |
$105.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.98
|
| Rate for Payer: Multiplan Commercial |
$116.92
|
|
|
ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]
|
Facility
|
OP
|
$155.90
|
|
|
Service Code
|
NDC 49702-231-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$132.51 |
| Rate for Payer: Adventist Health Commercial |
$31.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.92
|
| Rate for Payer: Blue Shield of California Commercial |
$95.10
|
| Rate for Payer: Blue Shield of California EPN |
$76.08
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.51
|
| Rate for Payer: Dignity Health Senior |
$132.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.50
|
| Rate for Payer: Heritage Provider Network Senior |
$96.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.13
|
| Rate for Payer: Multiplan Commercial |
$116.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.36
|
| Rate for Payer: TriValley Medical Group Senior |
$62.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$77.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.51
|
| Rate for Payer: Vantage Medical Group Senior |
$132.51
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.40
|
| Rate for Payer: Dignity Health Senior |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3.40
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$262.45 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.90
|
| Rate for Payer: Heritage Provider Network Senior |
$236.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.48
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
|
|
ABEMACICLIB 100 MG TABLET [219901]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4815-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$297.44 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.45
|
| Rate for Payer: Blue Shield of California Commercial |
$213.46
|
| Rate for Payer: Blue Shield of California EPN |
$170.77
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.44
|
| Rate for Payer: Dignity Health Senior |
$297.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.61
|
| Rate for Payer: Heritage Provider Network Senior |
$216.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$139.97
|
| Rate for Payer: TriValley Medical Group Senior |
$139.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.44
|
| Rate for Payer: Vantage Medical Group Senior |
$297.44
|
|
|
ABEMACICLIB 150 MG TABLET [219900]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-5337-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$262.45 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.90
|
| Rate for Payer: Heritage Provider Network Senior |
$236.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.48
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
|
|
ABEMACICLIB 150 MG TABLET [219900]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-5337-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$297.44 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.45
|
| Rate for Payer: Blue Shield of California Commercial |
$213.46
|
| Rate for Payer: Blue Shield of California EPN |
$170.77
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.44
|
| Rate for Payer: Dignity Health Senior |
$297.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.61
|
| Rate for Payer: Heritage Provider Network Senior |
$216.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$139.97
|
| Rate for Payer: TriValley Medical Group Senior |
$139.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.44
|
| Rate for Payer: Vantage Medical Group Senior |
$297.44
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-6216-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$297.44 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.45
|
| Rate for Payer: Blue Shield of California Commercial |
$213.46
|
| Rate for Payer: Blue Shield of California EPN |
$170.77
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.44
|
| Rate for Payer: Dignity Health Senior |
$297.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.61
|
| Rate for Payer: Heritage Provider Network Senior |
$216.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$139.97
|
| Rate for Payer: TriValley Medical Group Senior |
$139.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.44
|
| Rate for Payer: Vantage Medical Group Senior |
$297.44
|
|
|
ABEMACICLIB 200 MG TABLET [219899]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-6216-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$262.45 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.90
|
| Rate for Payer: Heritage Provider Network Senior |
$236.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.48
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
|
|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
|
IP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$262.45 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.90
|
| Rate for Payer: Heritage Provider Network Senior |
$236.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.48
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
|
|
ABEMACICLIB 50 MG TABLET [219902]
|
Facility
|
OP
|
$349.93
|
|
|
Service Code
|
NDC 0002-4483-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$297.44 |
| Rate for Payer: Adventist Health Commercial |
$69.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.45
|
| Rate for Payer: Blue Shield of California Commercial |
$213.46
|
| Rate for Payer: Blue Shield of California EPN |
$170.77
|
| Rate for Payer: Cash Price |
$192.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.44
|
| Rate for Payer: Dignity Health Senior |
$297.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.61
|
| Rate for Payer: Heritage Provider Network Senior |
$216.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$262.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$139.97
|
| Rate for Payer: TriValley Medical Group Senior |
$139.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.44
|
| Rate for Payer: Vantage Medical Group Senior |
$297.44
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
|
OP
|
$119.69
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.66 |
| Max. Negotiated Rate |
$101.74 |
| Rate for Payer: Adventist Health Commercial |
$23.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.77
|
| Rate for Payer: Blue Shield of California Commercial |
$73.01
|
| Rate for Payer: Blue Shield of California EPN |
$58.41
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.74
|
| Rate for Payer: Dignity Health Senior |
$101.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.09
|
| Rate for Payer: Heritage Provider Network Senior |
$74.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.78
|
| Rate for Payer: Multiplan Commercial |
$89.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.88
|
| Rate for Payer: TriValley Medical Group Senior |
$47.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.74
|
| Rate for Payer: Vantage Medical Group Senior |
$101.74
|
|
|
ABIRATERONE 250 MG TABLET [109776]
|
Facility
|
IP
|
$119.69
|
|
|
Service Code
|
NDC 57894-150-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.66 |
| Max. Negotiated Rate |
$89.77 |
| Rate for Payer: Adventist Health Commercial |
$23.94
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.03
|
| Rate for Payer: Heritage Provider Network Senior |
$81.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.92
|
| Rate for Payer: Multiplan Commercial |
$89.77
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
IP
|
$634.20
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.79 |
| Max. Negotiated Rate |
$475.65 |
| Rate for Payer: Adventist Health Commercial |
$126.84
|
| Rate for Payer: Cash Price |
$348.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$291.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.63
|
| Rate for Payer: Heritage Provider Network Senior |
$293.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.55
|
| Rate for Payer: Multiplan Commercial |
$475.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$229.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.98
|
|
|
ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION [106761]
|
Facility
|
OP
|
$634.20
|
|
|
Service Code
|
HCPCS J0586
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$475.65 |
| Rate for Payer: Adventist Health Commercial |
$126.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$338.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$435.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.76
|
| Rate for Payer: Blue Shield of California EPN |
$8.76
|
| Rate for Payer: Cash Price |
$348.81
|
| Rate for Payer: Cash Price |
$348.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$291.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.09
|
| Rate for Payer: Dignity Health Senior |
$10.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.63
|
| Rate for Payer: Heritage Provider Network Senior |
$293.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.55
|
| Rate for Payer: Multiplan Commercial |
$475.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$253.68
|
| Rate for Payer: TriValley Medical Group Senior |
$253.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$229.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.09
|
| Rate for Payer: Vantage Medical Group Senior |
$10.09
|
|
|
ACARBOSE 25 MG TABLET [22148]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 64380-758-06
|
| Hospital Charge Code |
901700029
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care 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 |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
