|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 0472037115
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.84
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.88
|
| Rate for Payer: Heritage Provider Network Senior |
$0.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
|
IP
|
$0.89
|
|
|
Service Code
|
NDC 0168003346
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.57
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Senior |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
NDC 6131424501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.88
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.29
|
| Rate for Payer: Heritage Provider Network Senior |
$8.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
NDC 6131424501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.47
|
| Rate for Payer: Blue Shield of California EPN |
$5.97
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.58
|
| Rate for Payer: Heritage Provider Network Senior |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.57
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.90
|
| Rate for Payer: TriValley Medical Group Senior |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10.40
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 0832051101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Senior |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 0832051100
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 0832051100
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
IP
|
$0.76
|
|
|
Service Code
|
NDC 0832051189
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
IP
|
$0.76
|
|
|
Service Code
|
NDC 0832051101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 0832051189
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Senior |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
NDC 6068770001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.72
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Senior |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
NDC 6068770011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.72
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Senior |
$0.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
NDC 6068770011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Senior |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
NDC 6068770001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Senior |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Vantage Medical Group Senior |
$0.95
|
|
|
BETHANECHOL CHLORIDE 5 MG TABLET [1045]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 0832051000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
BETHANECHOL CHLORIDE 5 MG TABLET [1045]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 0832051000
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
|
|
BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 9994080248
|
| 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
|
|
|
BETHANECHOL ORAL SUSPENSION COMPOUND 1 MG/ML [4080248]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 9994080248
|
| 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
|
|
|
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 |
$179.31 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| 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 |
$107.59
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$74.82
|
| 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) Medicare Advantage |
$74.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.26
|
| 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 |
$93.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Vantage Medical Group Senior |
$82.30
|
|
|
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: Aetna of CA Non-Gatekeeper |
$153.97
|
| Rate for Payer: Cash Price |
$107.59
|
| 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 Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$153.97
|
| Rate for Payer: Cash Price |
$107.59
|
| 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 Foundation Hospitals 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 |
$179.31 |
| Rate for Payer: Adventist Health Commercial |
$47.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| 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 |
$107.59
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$74.82
|
| 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) Medicare Advantage |
$74.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.26
|
| 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 |
$93.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Vantage Medical Group Senior |
$82.30
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
OP
|
$239.08
|
|
|
Service Code
|
NDC 9994081093
|
| 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 Non-Gatekeeper |
$147.75
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$119.59
|
| 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 |
$107.59
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$114.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 25 MG/ML TOPICAL [4081093]
|
Facility
|
OP
|
$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: Aetna of CA Non-Gatekeeper |
$147.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| 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 |
$107.59
|
| Rate for Payer: Cash Price |
$107.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$74.82
|
| 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) Medicare Advantage |
$74.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.26
|
| 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 |
$93.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.30
|
| Rate for Payer: Vantage Medical Group Senior |
$82.30
|
|
|
BEVACIZUMAB 25 MG/ML TOPICAL [4081093]
|
Facility
|
IP
|
$239.08
|
|
|
Service Code
|
NDC 9994081093
|
| 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: Aetna of CA Non-Gatekeeper |
$153.97
|
| Rate for Payer: Cash Price |
$107.59
|
| 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 Foundation Hospitals Medi-Cal |
$43.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.77
|
| Rate for Payer: Multiplan Commercial |
$179.31
|
|
