|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
OP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-10
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$194.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.09
|
| Rate for Payer: Blue Distinction Transplant |
$178.34
|
| Rate for Payer: Blue Shield of California Commercial |
$219.06
|
| Rate for Payer: Blue Shield of California EPN |
$173.58
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Cigna of CA HMO |
$208.06
|
| Rate for Payer: Cigna of CA PPO |
$208.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.65
|
| Rate for Payer: Dignity Health Media |
$252.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.65
|
| Rate for Payer: Global Benefits Group Commercial |
$178.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$222.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.34
|
| Rate for Payer: Multiplan Commercial |
$237.78
|
| Rate for Payer: Networks By Design Commercial |
$193.20
|
| Rate for Payer: Prime Health Services Commercial |
$252.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.62
|
| Rate for Payer: United Healthcare All Other HMO |
$148.62
|
| Rate for Payer: United Healthcare HMO Rider |
$148.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.65
|
| Rate for Payer: Vantage Medical Group Senior |
$252.65
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
IP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-10
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Blue Shield of California Commercial |
$211.63
|
| Rate for Payer: Blue Shield of California EPN |
$152.18
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Cigna of CA HMO |
$208.06
|
| Rate for Payer: Cigna of CA PPO |
$208.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.65
|
| Rate for Payer: Global Benefits Group Commercial |
$178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.34
|
| Rate for Payer: Multiplan Commercial |
$237.78
|
| Rate for Payer: Networks By Design Commercial |
$193.20
|
| Rate for Payer: Prime Health Services Commercial |
$252.65
|
|
|
TREPROSTINIL DIOLAMINE ER 5 MG TABLET, EXTENDED RELEASE [218793]
|
Facility
|
IP
|
$297.23
|
|
|
Service Code
|
NDC 66302-350-01
|
| Hospital Charge Code |
ERX218793
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Blue Shield of California Commercial |
$211.63
|
| Rate for Payer: Blue Shield of California EPN |
$152.18
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Cigna of CA HMO |
$208.06
|
| Rate for Payer: Cigna of CA PPO |
$208.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.65
|
| Rate for Payer: Global Benefits Group Commercial |
$178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.34
|
| Rate for Payer: Multiplan Commercial |
$237.78
|
| Rate for Payer: Networks By Design Commercial |
$193.20
|
| Rate for Payer: Prime Health Services Commercial |
$252.65
|
|
|
TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION [32934]
|
Facility
|
IP
|
$725.79
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$616.92 |
| Rate for Payer: Blue Shield of California Commercial |
$516.76
|
| Rate for Payer: Blue Shield of California EPN |
$371.60
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Cigna of CA HMO |
$508.05
|
| Rate for Payer: Cigna of CA PPO |
$508.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$290.32
|
| Rate for Payer: Galaxy Health WC |
$616.92
|
| Rate for Payer: Global Benefits Group Commercial |
$435.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.19
|
| Rate for Payer: Multiplan Commercial |
$580.63
|
| Rate for Payer: Networks By Design Commercial |
$362.90
|
| Rate for Payer: Prime Health Services Commercial |
$616.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.06
|
| Rate for Payer: United Healthcare All Other HMO |
$267.67
|
| Rate for Payer: United Healthcare HMO Rider |
$261.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.51
|
|
|
TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION [32934]
|
Facility
|
OP
|
$725.79
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.38 |
| Max. Negotiated Rate |
$616.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$354.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: Blue Distinction Transplant |
$435.47
|
| Rate for Payer: Blue Shield of California Commercial |
$534.91
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Cash Price |
$326.61
|
| Rate for Payer: Cigna of CA HMO |
$508.05
|
| Rate for Payer: Cigna of CA PPO |
$508.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Media |
$56.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.38
|
| Rate for Payer: Galaxy Health WC |
$616.92
|
| Rate for Payer: Global Benefits Group Commercial |
$435.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$544.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$92.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$91.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Multiplan Commercial |
$580.63
|
| Rate for Payer: Networks By Design Commercial |
$362.90
|
| Rate for Payer: Prime Health Services Commercial |
$616.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$435.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$362.90
|
| Rate for Payer: United Healthcare All Other HMO |
$362.90
|
| Rate for Payer: United Healthcare HMO Rider |
$362.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$362.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
|
OP
|
$181.45
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$354.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$354.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$354.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: Blue Distinction Transplant |
$108.87
|
| Rate for Payer: Blue Distinction Transplant |
$114.60
|
| Rate for Payer: Blue Shield of California Commercial |
$133.73
|
| Rate for Payer: Blue Shield of California Commercial |
$140.77
|
| Rate for Payer: Blue Shield of California EPN |
$111.54
|
| Rate for Payer: Blue Shield of California EPN |
$105.97
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$116.13
|
| Rate for Payer: Cigna of CA HMO |
$122.24
|
| Rate for Payer: Cigna of CA PPO |
$134.27
|
| Rate for Payer: Cigna of CA PPO |
$141.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Media |
$56.38
|
| Rate for Payer: Dignity Health Media |
$56.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.38
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Galaxy Health WC |
$154.23
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Global Benefits Group Commercial |
$108.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$136.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$143.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$92.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$92.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$91.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$91.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Multiplan Commercial |
$145.16
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Networks By Design Commercial |
$117.94
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Prime Health Services Commercial |
$154.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.50
|
| Rate for Payer: United Healthcare All Other HMO |
$90.72
|
| Rate for Payer: United Healthcare All Other HMO |
$95.50
|
| Rate for Payer: United Healthcare HMO Rider |
$90.72
|
| Rate for Payer: United Healthcare HMO Rider |
$95.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
|
|
TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION [32932]
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$162.35 |
| Rate for Payer: Blue Shield of California Commercial |
$135.99
|
| Rate for Payer: Blue Shield of California Commercial |
$129.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.79
|
| Rate for Payer: Blue Shield of California EPN |
$92.90
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$81.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.58
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Galaxy Health WC |
$154.23
|
| Rate for Payer: Global Benefits Group Commercial |
$108.87
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.55
|
| Rate for Payer: Multiplan Commercial |
$145.16
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$117.94
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Prime Health Services Commercial |
$154.23
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
|
IP
|
$362.90
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$308.46 |
| Rate for Payer: Blue Shield of California Commercial |
$258.38
|
| Rate for Payer: Blue Shield of California EPN |
$185.80
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cigna of CA HMO |
$254.03
|
| Rate for Payer: Cigna of CA PPO |
$254.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$145.16
|
| Rate for Payer: Galaxy Health WC |
$308.46
|
| Rate for Payer: Global Benefits Group Commercial |
$217.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.10
|
| Rate for Payer: Multiplan Commercial |
$290.32
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$308.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.03
|
| Rate for Payer: United Healthcare All Other HMO |
$133.84
|
| Rate for Payer: United Healthcare HMO Rider |
$130.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.76
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
|
OP
|
$362.90
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.38 |
| Max. Negotiated Rate |
$354.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$354.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: Blue Distinction Transplant |
$217.74
|
| Rate for Payer: Blue Shield of California Commercial |
$267.46
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cigna of CA HMO |
$254.03
|
| Rate for Payer: Cigna of CA PPO |
$254.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Media |
$56.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.38
|
| Rate for Payer: Galaxy Health WC |
$308.46
|
| Rate for Payer: Global Benefits Group Commercial |
$217.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$272.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$92.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$91.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.55
|
| Rate for Payer: Multiplan Commercial |
$290.32
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$308.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.45
|
| Rate for Payer: United Healthcare All Other HMO |
$181.45
|
| Rate for Payer: United Healthcare HMO Rider |
$181.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.06
|
| Rate for Payer: Blue Distinction Transplant |
$21.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26.05
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna of CA HMO |
$24.74
|
| Rate for Payer: Cigna of CA PPO |
$24.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.04
|
| Rate for Payer: Dignity Health Media |
$30.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$30.04
|
| Rate for Payer: Global Benefits Group Commercial |
$21.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$28.27
|
| Rate for Payer: Networks By Design Commercial |
$22.97
|
| Rate for Payer: Prime Health Services Commercial |
$30.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.67
|
| Rate for Payer: United Healthcare All Other HMO |
$17.67
|
| Rate for Payer: United Healthcare HMO Rider |
$17.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.04
|
| Rate for Payer: Vantage Medical Group Senior |
$30.04
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
IP
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Blue Shield of California Commercial |
$25.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna of CA HMO |
$24.74
|
| Rate for Payer: Cigna of CA PPO |
$24.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$30.04
|
| Rate for Payer: Global Benefits Group Commercial |
$21.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$28.27
|
| Rate for Payer: Networks By Design Commercial |
$22.97
|
| Rate for Payer: Prime Health Services Commercial |
$30.04
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.68
|
| Rate for Payer: Blue Distinction Transplant |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$24.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.29
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Media |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.52
|
| Rate for Payer: United Healthcare HMO Rider |
$16.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Blue Shield of California Commercial |
$23.52
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
1711646
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.68
|
| Rate for Payer: Blue Distinction Transplant |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$24.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.29
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna of CA HMO |
$23.12
|
| Rate for Payer: Cigna of CA PPO |
$23.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Media |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.21
|
| Rate for Payer: Galaxy Health WC |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$26.42
|
| Rate for Payer: Networks By Design Commercial |
$21.47
|
| Rate for Payer: Prime Health Services Commercial |
$28.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO |
$16.52
|
| Rate for Payer: United Healthcare HMO Rider |
$16.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRIAMCINOLONE 9 MG-MOXIFLOX 0.6 MG/0.6 ML IN WATER(PF)INTRAOCULAR SUSP [221760]
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.83
|
| Rate for Payer: Blue Distinction Transplant |
$18.36
|
| Rate for Payer: Blue Shield of California Commercial |
$22.55
|
| Rate for Payer: Blue Shield of California EPN |
$17.87
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cigna of CA HMO |
$21.42
|
| Rate for Payer: Cigna of CA PPO |
$21.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.01
|
| Rate for Payer: Dignity Health Media |
$26.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$26.01
|
| Rate for Payer: Global Benefits Group Commercial |
$18.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$26.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.30
|
| Rate for Payer: United Healthcare All Other HMO |
$15.30
|
| Rate for Payer: United Healthcare HMO Rider |
$15.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.01
|
| Rate for Payer: Vantage Medical Group Senior |
$26.01
|
|
|
TRIAMCINOLONE 9 MG-MOXIFLOX 0.6 MG/0.6 ML IN WATER(PF)INTRAOCULAR SUSP [221760]
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Blue Shield of California Commercial |
$21.79
|
| Rate for Payer: Blue Shield of California EPN |
$15.67
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cigna of CA HMO |
$21.42
|
| Rate for Payer: Cigna of CA PPO |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$26.01
|
| Rate for Payer: Global Benefits Group Commercial |
$18.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$26.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.55
|
| Rate for Payer: United Healthcare All Other HMO |
$11.29
|
| Rate for Payer: United Healthcare HMO Rider |
$11.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.10
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 33342-327-80
|
| Hospital Charge Code |
1743435
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$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 |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Distinction Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Media |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 45802-063-36
|
| Hospital Charge Code |
1743435
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 33342-327-80
|
| Hospital Charge Code |
1743435
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| 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 |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0168-0003-80
|
| Hospital Charge Code |
1743435
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 45802-063-36
|
| Hospital Charge Code |
1743435
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| 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 |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Distinction Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Media |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0168-0003-80
|
| Hospital Charge Code |
1743435
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Media |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT [8117]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0713-0229-15
|
| Hospital Charge Code |
1743372
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Media |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT [8117]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 45802-054-35
|
| Hospital Charge Code |
1743372
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Distinction Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Media |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
