|
BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994-0802-48
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$127.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.40
|
| Rate for Payer: Blue Shield of California Commercial |
$81.29
|
| Rate for Payer: Blue Shield of California EPN |
$81.29
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.35
|
| Rate for Payer: Dignity Health Senior |
$80.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$73.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.69
|
| Rate for Payer: Heritage Provider Network Senior |
$110.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.04
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$95.63
|
| Rate for Payer: TriValley Medical Group Senior |
$95.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.35
|
| Rate for Payer: Vantage Medical Group Senior |
$80.35
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [38022]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$179.31 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.69
|
| Rate for Payer: Heritage Provider Network Senior |
$110.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.16
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$179.31 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.69
|
| Rate for Payer: Heritage Provider Network Senior |
$110.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.16
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVITREAL INJ [4080972]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$127.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.40
|
| Rate for Payer: Blue Shield of California Commercial |
$81.29
|
| Rate for Payer: Blue Shield of California EPN |
$81.29
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.35
|
| Rate for Payer: Dignity Health Senior |
$80.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$73.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.69
|
| Rate for Payer: Heritage Provider Network Senior |
$110.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.04
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$95.63
|
| Rate for Payer: TriValley Medical Group Senior |
$95.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.35
|
| Rate for Payer: Vantage Medical Group Senior |
$80.35
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
NDC 9994-0810-93
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$179.31 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.86
|
| Rate for Payer: Heritage Provider Network Senior |
$161.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
NDC 9994-0810-93
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$203.22 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$127.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.31
|
| Rate for Payer: Blue Shield of California Commercial |
$145.84
|
| Rate for Payer: Blue Shield of California EPN |
$116.67
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.22
|
| Rate for Payer: Dignity Health Senior |
$203.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.99
|
| Rate for Payer: Heritage Provider Network Senior |
$147.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$167.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167.36
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$95.63
|
| Rate for Payer: TriValley Medical Group Senior |
$95.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$119.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$203.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.22
|
| Rate for Payer: Vantage Medical Group Senior |
$203.22
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
OP
|
$209.32
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.85 |
| Max. Negotiated Rate |
$180.71 |
| Rate for Payer: Adventist Health Commercial |
$41.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.71
|
| Rate for Payer: Blue Shield of California Commercial |
$71.17
|
| Rate for Payer: Blue Shield of California EPN |
$71.17
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cash Price |
$115.13
|
| Rate for Payer: Cash Price |
$115.13
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.73
|
| Rate for Payer: Dignity Health Senior |
$31.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$28.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.92
|
| Rate for Payer: Heritage Provider Network Senior |
$96.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$99.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.35
|
| Rate for Payer: Multiplan Commercial |
$156.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.73
|
| Rate for Payer: TriValley Medical Group Senior |
$83.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.73
|
| Rate for Payer: Vantage Medical Group Senior |
$31.73
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION [225272]
|
Facility
|
IP
|
$209.32
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.89 |
| Max. Negotiated Rate |
$156.99 |
| Rate for Payer: Adventist Health Commercial |
$41.86
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cash Price |
$115.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.92
|
| Rate for Payer: Heritage Provider Network Senior |
$96.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.33
|
| Rate for Payer: Multiplan Commercial |
$156.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.31
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [216412]
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.78
|
| Rate for Payer: Heritage Provider Network Senior |
$52.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.75
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [216412]
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$98.42 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.42
|
| Rate for Payer: Blue Shield of California Commercial |
$38.76
|
| Rate for Payer: Blue Shield of California EPN |
$38.76
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.81
|
| Rate for Payer: Dignity Health Senior |
$43.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$39.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.78
|
| Rate for Payer: Heritage Provider Network Senior |
$52.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.18
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.81
|
| Rate for Payer: Vantage Medical Group Senior |
$43.81
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
NDC 16729-023-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Senior |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 41616-485-83
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.33
|
| 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
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
NDC 16729-023-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 47335-485-83
|
| Hospital Charge Code |
901700029
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care 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 |
$0.29
|
| Rate for Payer: Cash Price |
$0.33
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 41616-485-83
|
| Hospital Charge Code |
901700029
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care 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 |
$0.29
|
| Rate for Payer: Cash Price |
$0.33
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BICALUTAMIDE 50 MG TABLET [15746]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 47335-485-83
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.33
|
| 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
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-111-06
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARB HEMODIALYSIS SOLN WITHOUT CALCIUM NO 16 POT 4 MEQ-MAG 1.5 MEQ/L [121436]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-111-06
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-114-06
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARBONATE DIALYSIS SOLN WITHOUT CALCIUM NO15 POT 4 MEQ-MAG 1.2 MEQ/L [121260]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-114-06
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.2 K 2 MEQ-CA 3.5 MEQ-MG 1 MEQ/L [120070]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS A4706
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.2 K 2 MEQ-CA 3.5 MEQ-MG 1 MEQ/L [120070]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS A4706
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L [100176]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 24571-105-06
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
BICARBONATE HEMODIALYSIS SOLUTION NO.9 K 4 MEQ-CA 2.5 MEQ-MG 1.5 MEQ/L [100176]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 24571-105-06
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
