|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 45802-055-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 45802-055-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 45802-055-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA 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 |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| 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 Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| 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 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 45802-055-36
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 21922-063-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| 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 |
$0.07
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| 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 0.5 % TOPICAL CREAM [8114]
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 45802-065-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM [8114]
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
NDC 45802-065-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM [8114]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
NDC 0168-0002-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM [8114]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 0168-0002-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL OINTMENT [8119]
|
Facility
|
IP
|
$0.65
|
|
|
Service Code
|
NDC 45802-049-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL OINTMENT [8119]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 45802-049-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [11584]
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| 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 Medi-Cal |
$2.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| 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 |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| 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
|
HCPCS J3301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.41
|
| Rate for Payer: Cash Price |
$1.60
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$1.80
|
| 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 |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML MED NEB SOLUTION [4080950]
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
NDC 0003-0293-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8.29
|
| Rate for Payer: Blue Shield of California EPN |
$5.46
|
| Rate for Payer: Cash Price |
$6.18
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| 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 |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| 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 |
$8.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.90
|
| Rate for Payer: Cash Price |
$6.18
|
| 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 Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.86
|
| 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 MED NEB SOLUTION [4080950]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 0003-0293-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| 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 |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.00
|
| Rate for Payer: Cash Price |
$6.27
|
| 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 Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| 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
|
$11.40
|
|
|
Service Code
|
NDC 0003-0293-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8.41
|
| Rate for Payer: Blue Shield of California EPN |
$5.54
|
| Rate for Payer: Cash Price |
$6.27
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$7.06
|
| 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 SUSPENSION FOR INJECTION [8120]
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Adventist Health Commercial |
$1.94
|
| Rate for Payer: Adventist Health Commercial |
$2.13
|
| Rate for Payer: Adventist Health Commercial |
$2.17
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7.99
|
| Rate for Payer: Blue Shield of California Commercial |
$7.27
|
| Rate for Payer: Blue Shield of California Commercial |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$7.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7.87
|
| Rate for Payer: Blue Shield of California EPN |
$5.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.05
|
| Rate for Payer: Blue Shield of California EPN |
$4.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.79
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cigna of CA HMO |
$7.58
|
| Rate for Payer: Cigna of CA HMO |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$7.28
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$6.80
|
| Rate for Payer: Cigna of CA PPO |
$7.58
|
| Rate for Payer: Cigna of CA PPO |
$6.80
|
| Rate for Payer: Cigna of CA PPO |
$7.47
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.27
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$4.16
|
| Rate for Payer: EPIC Health Plan Senior |
$3.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4.33
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Galaxy Health WC |
$8.84
|
| Rate for Payer: Galaxy Health WC |
$9.07
|
| Rate for Payer: Galaxy Health WC |
$9.21
|
| Rate for Payer: Galaxy Health WC |
$8.37
|
| Rate for Payer: Galaxy Health WC |
$8.25
|
| 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 |
$6.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| 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 |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.44
|
| 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: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$7.77
|
| Rate for Payer: Multiplan Commercial |
$8.66
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$5.42
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$5.33
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.07
|
| Rate for Payer: Prime Health Services Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$8.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$8.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.74
|
| Rate for Payer: United Healthcare All Other HMO |
$3.80
|
| Rate for Payer: United Healthcare All Other HMO |
$3.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3.64
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.81
|
| Rate for Payer: United Healthcare HMO Rider |
$3.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3.87
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]
|
Facility
|
OP
|
$10.67
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Adventist Health Commercial |
$2.13
|
| Rate for Payer: Adventist Health Commercial |
$2.17
|
| Rate for Payer: Adventist Health Commercial |
$1.94
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.47
|
| 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 |
$9.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cigna of CA HMO |
$7.58
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$7.28
|
| Rate for Payer: Cigna of CA HMO |
$6.80
|
| Rate for Payer: Cigna of CA HMO |
$7.47
|
| Rate for Payer: Cigna of CA PPO |
$7.28
|
| Rate for Payer: Cigna of CA PPO |
$7.47
|
| Rate for Payer: Cigna of CA PPO |
$7.58
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| 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 |
$8.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Senior |
$3.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4.16
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Senior |
$4.33
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.37
|
| Rate for Payer: Galaxy Health WC |
$8.25
|
| Rate for Payer: Galaxy Health WC |
$9.21
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Galaxy Health WC |
$9.07
|
| Rate for Payer: Galaxy Health WC |
$8.84
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Global Benefits Group Commercial |
$5.91
|
| Rate for Payer: Global Benefits Group Commercial |
$5.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
| Rate for Payer: Multiplan Commercial |
$8.66
|
| Rate for Payer: Multiplan Commercial |
$7.77
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$5.33
|
| Rate for Payer: Networks By Design Commercial |
$5.42
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Prime Health Services Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$8.84
|
| Rate for Payer: Prime Health Services Commercial |
$8.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$9.07
|
| Rate for Payer: Prime Health Services Commercial |
$9.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.83
|
| 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 |
$6.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3.64
|
| Rate for Payer: United Healthcare All Other HMO |
$3.80
|
| Rate for Payer: United Healthcare All Other HMO |
$3.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3.81
|
| Rate for Payer: United Healthcare HMO Rider |
$3.87
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8.37
|
| Rate for Payer: Vantage Medical Group Senior |
$9.07
|
| Rate for Payer: Vantage Medical Group Senior |
$8.84
|
| Rate for Payer: Vantage Medical Group Senior |
$9.21
|
|
|
TRIAMCINOLONE ACETONIDE 55 MCG NASAL SPRAY AEROSOL [19808]
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
NDC 4116758003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| 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 |
$1.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.82
|
| Rate for Payer: Cash Price |
$0.74
|
| 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 Medi-Cal |
$1.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.94
|
| 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 55 MCG NASAL SPRAY AEROSOL [19808]
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
NDC 4116758003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.74
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.83
|
| 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 MOXIFLOXACIN VANCOMYCIN (TRI-MOXI-VANC) OPHTHALMIC INJECTION [4081389]
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Cash Price |
$13.75
|
| 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 Senior |
$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 |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| 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 |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
TRIAMCINOLONE MOXIFLOXACIN VANCOMYCIN (TRI-MOXI-VANC) OPHTHALMIC INJECTION [4081389]
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| 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 |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.35
|
| Rate for Payer: Cash Price |
$13.75
|
| 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 Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| 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 |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| 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
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 0527-1632-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| 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 72578-090-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| 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 |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| 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 Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| 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
|
|
