|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [11584]
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
1720181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.24
|
| Rate for Payer: Blue Distinction Transplant |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Media |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [11584]
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
1720181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.03
|
| Rate for Payer: Cigna of CA PPO |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.32
|
| Rate for Payer: Networks By Design Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.96
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML MED NEB SOLUTION [4080950]
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
NDC 0003-0293-20
|
| Hospital Charge Code |
1720190
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Blue Shield of California Commercial |
$8.12
|
| Rate for Payer: Blue Shield of California EPN |
$5.84
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML MED NEB SOLUTION [4080950]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 0003-0293-20
|
| Hospital Charge Code |
1720190
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.79
|
| Rate for Payer: Blue Distinction Transplant |
$6.84
|
| Rate for Payer: Blue Shield of California Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Media |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML MED NEB SOLUTION [4080950]
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
NDC 0003-0293-05
|
| Hospital Charge Code |
1720077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Blue Shield of California Commercial |
$8.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML MED NEB SOLUTION [4080950]
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
NDC 0003-0293-05
|
| Hospital Charge Code |
1720077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.69
|
| Rate for Payer: Blue Distinction Transplant |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.56
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Media |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO |
$5.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
1720077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.24
|
| Rate for Payer: Blue Distinction Transplant |
$6.12
|
| Rate for Payer: Blue Distinction Transplant |
$5.83
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.16
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$6.80
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: Cigna of CA PPO |
$6.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$8.25
|
| Rate for Payer: Dignity Health Media |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.88
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Galaxy Health WC |
$8.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$7.77
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.86
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
1720190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Blue Shield of California Commercial |
$8.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.09
|
| Rate for Payer: Blue Shield of California Commercial |
$7.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7.01
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.32
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA HMO |
$6.90
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$7.28
|
| Rate for Payer: Cigna of CA PPO |
$7.28
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$6.90
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Galaxy Health WC |
$8.84
|
| Rate for Payer: Galaxy Health WC |
$8.37
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Global Benefits Group Commercial |
$6.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$5.91
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Prime Health Services Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$8.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.11
|
| Rate for Payer: United Healthcare HMO Rider |
$3.59
|
| Rate for Payer: United Healthcare HMO Rider |
$3.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.76
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
1720190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.24
|
| Rate for Payer: Blue Distinction Transplant |
$6.84
|
| Rate for Payer: Blue Distinction Transplant |
$6.24
|
| Rate for Payer: Blue Distinction Transplant |
$5.98
|
| Rate for Payer: Blue Distinction Transplant |
$5.91
|
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cigna of CA HMO |
$6.90
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$7.28
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$6.90
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Media |
$8.47
|
| Rate for Payer: Dignity Health Media |
$8.84
|
| Rate for Payer: Dignity Health Media |
$9.69
|
| Rate for Payer: Dignity Health Media |
$8.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Galaxy Health WC |
$8.37
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Galaxy Health WC |
$8.84
|
| Rate for Payer: Global Benefits Group Commercial |
$6.24
|
| Rate for Payer: Global Benefits Group Commercial |
$5.91
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$8.84
|
| Rate for Payer: Prime Health Services Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.92
|
| Rate for Payer: United Healthcare All Other HMO |
$4.98
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$4.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.84
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.37
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
1720077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California Commercial |
$6.91
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.97
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cigna of CA HMO |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$6.80
|
| Rate for Payer: Cigna of CA PPO |
$6.80
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.88
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Galaxy Health WC |
$8.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$7.77
|
| Rate for Payer: Networks By Design Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Prime Health Services Commercial |
$8.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO |
$3.76
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$3.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
|
|
TRIAMCINOLONE ACETONIDE 55 MCG NASAL SPRAY AEROSOL [19808]
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
NDC 4116758003
|
| Hospital Charge Code |
NDG19808
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.94
|
| Rate for Payer: Cigna of CA PPO |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.14
|
|
|
TRIAMCINOLONE ACETONIDE 55 MCG NASAL SPRAY AEROSOL [19808]
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
NDC 4116758003
|
| Hospital Charge Code |
NDG19808
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Distinction Transplant |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.94
|
| Rate for Payer: Cigna of CA PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.14
|
| Rate for Payer: Dignity Health Media |
$1.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Vantage Medical Group Senior |
$1.14
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML INTRAOCULAR SUSPENSION [89128]
|
Facility
|
OP
|
$193.31
|
|
|
Service Code
|
CPT J3300
|
| Hospital Charge Code |
1740433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$164.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Blue Distinction Transplant |
$115.99
|
| Rate for Payer: Blue Shield of California Commercial |
$142.47
|
| Rate for Payer: Blue Shield of California EPN |
$4.51
|
| Rate for Payer: Cash Price |
$86.99
|
| Rate for Payer: Cash Price |
$86.99
|
| Rate for Payer: Cigna of CA HMO |
$135.32
|
| Rate for Payer: Cigna of CA PPO |
$135.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.31
|
| Rate for Payer: Dignity Health Media |
$164.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$77.32
|
| Rate for Payer: Galaxy Health WC |
$164.31
|
| Rate for Payer: Global Benefits Group Commercial |
$115.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$144.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.39
|
| Rate for Payer: Multiplan Commercial |
$154.65
|
| Rate for Payer: Networks By Design Commercial |
$96.66
|
| Rate for Payer: Prime Health Services Commercial |
$164.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.66
|
| Rate for Payer: United Healthcare All Other HMO |
$96.66
|
| Rate for Payer: United Healthcare HMO Rider |
$96.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.31
|
| Rate for Payer: Vantage Medical Group Senior |
$164.31
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML INTRAOCULAR SUSPENSION [89128]
|
Facility
|
IP
|
$193.31
|
|
|
Service Code
|
CPT J3300
|
| Hospital Charge Code |
1740433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.39 |
| Max. Negotiated Rate |
$164.31 |
| Rate for Payer: Blue Shield of California Commercial |
$137.64
|
| Rate for Payer: Blue Shield of California EPN |
$98.97
|
| Rate for Payer: Cash Price |
$86.99
|
| Rate for Payer: Cigna of CA HMO |
$135.32
|
| Rate for Payer: Cigna of CA PPO |
$135.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$77.32
|
| Rate for Payer: Galaxy Health WC |
$164.31
|
| Rate for Payer: Global Benefits Group Commercial |
$115.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.39
|
| Rate for Payer: Multiplan Commercial |
$154.65
|
| Rate for Payer: Networks By Design Commercial |
$96.66
|
| Rate for Payer: Prime Health Services Commercial |
$164.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.99
|
| Rate for Payer: United Healthcare All Other HMO |
$71.29
|
| Rate for Payer: United Healthcare HMO Rider |
$69.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.79
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML SUPRACHOROIDAL SUSPENSION [235246]
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT J3299
|
| Hospital Charge Code |
NDG235246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$305.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.67
|
| Rate for Payer: Blue Distinction Transplant |
$1,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,621.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,284.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.73
|
| Rate for Payer: Dignity Health Media |
$53.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.58
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,650.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$79.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$78.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.10
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.44
|
| Rate for Payer: Vantage Medical Group Senior |
$53.44
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML SUPRACHOROIDAL SUSPENSION [235246]
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT J3299
|
| Hospital Charge Code |
NDG235246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Blue Shield of California Commercial |
$1,566.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,126.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,540.00
|
| Rate for Payer: Cigna of CA PPO |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$880.00
|
| Rate for Payer: Galaxy Health WC |
$1,870.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Multiplan Commercial |
$1,760.00
|
| Rate for Payer: Networks By Design Commercial |
$1,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$830.72
|
| Rate for Payer: United Healthcare All Other HMO |
$811.36
|
| Rate for Payer: United Healthcare HMO Rider |
$793.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.00
|
|
|
TRIAMCINOLONE MOXIFLOXACIN VANCOMYCIN (TRI-MOXI-VANC) OPHTHALMIC INJECTION [4081389]
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
ERX4081389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.75
|
| Rate for Payer: Blue Distinction Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.42
|
| Rate for Payer: Blue Shield of California EPN |
$14.60
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Media |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
TRIAMCINOLONE MOXIFLOXACIN VANCOMYCIN (TRI-MOXI-VANC) OPHTHALMIC INJECTION [4081389]
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
ERX4081389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Blue Shield of California Commercial |
$17.80
|
| Rate for Payer: Blue Shield of California EPN |
$12.80
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.44
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.25
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 0378-2537-10
|
| Hospital Charge Code |
1711917
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 0378-2537-01
|
| Hospital Charge Code |
1711917
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0781-2074-10
|
| Hospital Charge Code |
1711917
|
|
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
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 0378-2537-01
|
| Hospital Charge Code |
1711917
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 0378-2537-10
|
| Hospital Charge Code |
1711917
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| 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 |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
NDC 51079-935-01
|
| Hospital Charge Code |
1711917
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Distinction Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
NDC 51079-935-20
|
| Hospital Charge Code |
1711917
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Distinction Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.30
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
