|
BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 9994080247
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BECLOMETHASONE ORAL EMULSION COMPOUND 1 MG/ML [4080247]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994080247
|
| 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: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| 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 Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
BEER [4080757]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 9994080757
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Senior |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
BEER [4080757]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
NDC 9994080757
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.92
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$32,568.79
|
|
|
Service Code
|
MSDRG 886
|
| Min. Negotiated Rate |
$24,305.07 |
| Max. Negotiated Rate |
$32,568.79 |
| Rate for Payer: EPIC Health Plan Medicare |
$24,305.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,305.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,950.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,568.79
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION [153042]
|
Facility
|
OP
|
$1,163.86
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$872.89 |
| Rate for Payer: Adventist Health Commercial |
$232.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.96
|
| Rate for Payer: Cash Price |
$523.74
|
| Rate for Payer: Cash Price |
$523.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$535.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.87
|
| Rate for Payer: Heritage Provider Network Senior |
$538.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$555.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$872.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$465.54
|
| Rate for Payer: TriValley Medical Group Senior |
$465.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$420.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$385.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION [153042]
|
Facility
|
IP
|
$1,163.86
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.66 |
| Max. Negotiated Rate |
$872.89 |
| Rate for Payer: Adventist Health Commercial |
$232.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$749.53
|
| Rate for Payer: Cash Price |
$523.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$535.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.87
|
| Rate for Payer: Heritage Provider Network Senior |
$538.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.96
|
| Rate for Payer: Multiplan Commercial |
$872.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$420.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$385.35
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]
|
Facility
|
OP
|
$808.33
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$606.25 |
| Rate for Payer: Vantage Medical Group Senior |
$64.13
|
| Rate for Payer: Adventist Health Commercial |
$161.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$499.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.56
|
| Rate for Payer: Blue Shield of California Commercial |
$52.90
|
| Rate for Payer: Blue Shield of California EPN |
$52.90
|
| Rate for Payer: Cash Price |
$363.75
|
| Rate for Payer: Cash Price |
$363.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$371.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$517.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.26
|
| Rate for Payer: Heritage Provider Network Senior |
$374.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$385.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.12
|
| Rate for Payer: Multiplan Commercial |
$606.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$323.33
|
| Rate for Payer: TriValley Medical Group Senior |
$323.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$292.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$267.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.13
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION [108842]
|
Facility
|
IP
|
$808.33
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.31 |
| Max. Negotiated Rate |
$606.25 |
| Rate for Payer: Adventist Health Commercial |
$161.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$520.56
|
| Rate for Payer: Cash Price |
$363.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$371.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.26
|
| Rate for Payer: Heritage Provider Network Senior |
$374.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.08
|
| Rate for Payer: Multiplan Commercial |
$606.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$292.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$267.64
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION [108843]
|
Facility
|
IP
|
$2,694.23
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$487.66 |
| Max. Negotiated Rate |
$2,020.67 |
| Rate for Payer: Adventist Health Commercial |
$538.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,735.08
|
| Rate for Payer: Cash Price |
$1,212.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,239.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,454.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,247.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,247.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$487.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.56
|
| Rate for Payer: Multiplan Commercial |
$2,020.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$973.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$892.06
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION [108843]
|
Facility
|
OP
|
$2,694.23
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$2,020.67 |
| Rate for Payer: Adventist Health Commercial |
$538.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,665.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.56
|
| Rate for Payer: Blue Shield of California Commercial |
$52.90
|
| Rate for Payer: Blue Shield of California EPN |
$52.90
|
| Rate for Payer: Cash Price |
$1,212.40
|
| Rate for Payer: Cash Price |
$1,212.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,239.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,724.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,247.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,247.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,285.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$487.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.12
|
| Rate for Payer: Multiplan Commercial |
$2,020.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,077.69
|
| Rate for Payer: TriValley Medical Group Senior |
$1,077.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$973.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$892.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.13
|
| Rate for Payer: Vantage Medical Group Senior |
$64.13
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]
|
Facility
|
IP
|
$26.42
|
|
|
Service Code
|
NDC 0574704512
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$19.82 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.01
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.89
|
| Rate for Payer: Heritage Provider Network Senior |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$19.82
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]
|
Facility
|
IP
|
$26.42
|
|
|
Service Code
|
NDC 0574704501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$19.82 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.01
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.89
|
| Rate for Payer: Heritage Provider Network Senior |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$19.82
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]
|
Facility
|
OP
|
$26.42
|
|
|
Service Code
|
NDC 0574704501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$22.46 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.22
|
| Rate for Payer: Blue Shield of California Commercial |
$16.12
|
| Rate for Payer: Blue Shield of California EPN |
$12.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.35
|
| Rate for Payer: Heritage Provider Network Senior |
$16.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.49
|
| Rate for Payer: Multiplan Commercial |
$19.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.57
|
| Rate for Payer: TriValley Medical Group Senior |
$10.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.46
|
| Rate for Payer: Vantage Medical Group Senior |
$22.46
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY [111311]
|
Facility
|
OP
|
$26.42
|
|
|
Service Code
|
NDC 0574704512
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$22.46 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.22
|
| Rate for Payer: Blue Shield of California Commercial |
$16.12
|
| Rate for Payer: Blue Shield of California EPN |
$12.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.35
|
| Rate for Payer: Heritage Provider Network Senior |
$16.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.49
|
| Rate for Payer: Multiplan Commercial |
$19.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.57
|
| Rate for Payer: TriValley Medical Group Senior |
$10.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.46
|
| Rate for Payer: Vantage Medical Group Senior |
$22.46
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY [24731]
|
Facility
|
IP
|
$32.11
|
|
|
Service Code
|
NDC 0574704012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$24.08 |
| Rate for Payer: Adventist Health Commercial |
$6.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.68
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.74
|
| Rate for Payer: Heritage Provider Network Senior |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$24.08
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY [24731]
|
Facility
|
IP
|
$32.11
|
|
|
Service Code
|
NDC 0574704001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$24.08 |
| Rate for Payer: Adventist Health Commercial |
$6.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.68
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.74
|
| Rate for Payer: Heritage Provider Network Senior |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$24.08
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY [24731]
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 0574704012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$27.29 |
| Rate for Payer: Adventist Health Commercial |
$6.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.06
|
| Rate for Payer: Blue Shield of California Commercial |
$19.59
|
| Rate for Payer: Blue Shield of California EPN |
$15.67
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.88
|
| Rate for Payer: Heritage Provider Network Senior |
$19.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.48
|
| Rate for Payer: Multiplan Commercial |
$24.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.84
|
| Rate for Payer: TriValley Medical Group Senior |
$12.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.29
|
| Rate for Payer: Vantage Medical Group Senior |
$27.29
|
|
|
BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY [24731]
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
NDC 0574704001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$27.29 |
| Rate for Payer: Adventist Health Commercial |
$6.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.06
|
| Rate for Payer: Blue Shield of California Commercial |
$19.59
|
| Rate for Payer: Blue Shield of California EPN |
$15.67
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.88
|
| Rate for Payer: Heritage Provider Network Senior |
$19.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.48
|
| Rate for Payer: Multiplan Commercial |
$24.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.84
|
| Rate for Payer: TriValley Medical Group Senior |
$12.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.29
|
| Rate for Payer: Vantage Medical Group Senior |
$27.29
|
|
|
BENAZEPRIL 10 MG TABLET [9220]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 6516275210
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
BENAZEPRIL 10 MG TABLET [9220]
|
Facility
|
OP
|
$0.82
|
|
|
Service Code
|
NDC 5026811015
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
BENAZEPRIL 10 MG TABLET [9220]
|
Facility
|
OP
|
$0.82
|
|
|
Service Code
|
NDC 5026811011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
BENAZEPRIL 10 MG TABLET [9220]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 4354733610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
BENAZEPRIL 10 MG TABLET [9220]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 6516275210
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
BENAZEPRIL 10 MG TABLET [9220]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 6586211601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
