|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
IP
|
$2.63
|
|
|
Service Code
|
NDC 60687-721-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.84
|
| Rate for Payer: Cigna of CA PPO |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.71
|
| Rate for Payer: Prime Health Services Commercial |
$2.24
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 60505-0257-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 68001-574-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
|
OP
|
$2.63
|
|
|
Service Code
|
NDC 60687-721-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.62
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.84
|
| Rate for Payer: Cigna of CA PPO |
$1.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.71
|
| Rate for Payer: Prime Health Services Commercial |
$2.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: Vantage Medical Group Senior |
$2.24
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 68001-575-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
NDC 68001-575-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]
|
Facility
|
IP
|
$47.28
|
|
|
Service Code
|
NDC 24208-342-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Adventist Health Commercial |
$9.46
|
| Rate for Payer: Blue Shield of California Commercial |
$34.89
|
| Rate for Payer: Blue Shield of California EPN |
$22.98
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Cigna of CA HMO |
$33.10
|
| Rate for Payer: Cigna of CA PPO |
$33.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.91
|
| Rate for Payer: EPIC Health Plan Senior |
$18.91
|
| Rate for Payer: Galaxy Health WC |
$40.19
|
| Rate for Payer: Global Benefits Group Commercial |
$28.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Multiplan Commercial |
$37.82
|
| Rate for Payer: Networks By Design Commercial |
$30.73
|
| Rate for Payer: Prime Health Services Commercial |
$40.19
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]
|
Facility
|
OP
|
$47.28
|
|
|
Service Code
|
NDC 24208-342-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Cigna of CA PPO |
$33.10
|
| Rate for Payer: Cigna of CA HMO |
$33.10
|
| Rate for Payer: Adventist Health Commercial |
$9.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.03
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.91
|
| Rate for Payer: EPIC Health Plan Senior |
$18.91
|
| Rate for Payer: Galaxy Health WC |
$40.19
|
| Rate for Payer: Global Benefits Group Commercial |
$28.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.10
|
| Rate for Payer: Multiplan Commercial |
$37.82
|
| Rate for Payer: Networks By Design Commercial |
$30.73
|
| Rate for Payer: Prime Health Services Commercial |
$40.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO |
$23.64
|
| Rate for Payer: United Healthcare HMO Rider |
$23.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.19
|
| Rate for Payer: Vantage Medical Group Senior |
$40.19
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) [21135]
|
Facility
|
IP
|
$29.55
|
|
|
Service Code
|
NDC 47335-788-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$25.12 |
| Rate for Payer: Adventist Health Commercial |
$5.91
|
| Rate for Payer: Blue Shield of California Commercial |
$21.81
|
| Rate for Payer: Blue Shield of California EPN |
$14.36
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$20.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11.82
|
| Rate for Payer: Galaxy Health WC |
$25.12
|
| Rate for Payer: Global Benefits Group Commercial |
$17.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.09
|
| Rate for Payer: Multiplan Commercial |
$23.64
|
| Rate for Payer: Networks By Design Commercial |
$19.21
|
| Rate for Payer: Prime Health Services Commercial |
$25.12
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) [21135]
|
Facility
|
OP
|
$29.55
|
|
|
Service Code
|
NDC 47335-788-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$25.12 |
| Rate for Payer: Adventist Health Commercial |
$5.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.15
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$20.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11.82
|
| Rate for Payer: Galaxy Health WC |
$25.12
|
| Rate for Payer: Global Benefits Group Commercial |
$17.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.68
|
| Rate for Payer: Multiplan Commercial |
$23.64
|
| Rate for Payer: Networks By Design Commercial |
$19.21
|
| Rate for Payer: Prime Health Services Commercial |
$25.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.78
|
| Rate for Payer: United Healthcare All Other HMO |
$14.78
|
| Rate for Payer: United Healthcare HMO Rider |
$14.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.12
|
| Rate for Payer: Vantage Medical Group Senior |
$25.12
|
|
|
DESMOPRESSIN 25 MCG 1/4 TAB [4080522]
|
Facility
|
IP
|
$3.02
|
|
|
Service Code
|
NDC 9994-0805-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO |
$2.11
|
| Rate for Payer: Cigna of CA PPO |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: EPIC Health Plan Senior |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.42
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$2.57
|
|
|
DESMOPRESSIN 25 MCG 1/4 TAB [4080522]
|
Facility
|
OP
|
$3.02
|
|
|
Service Code
|
NDC 9994-0805-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.85
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO |
$2.11
|
| Rate for Payer: Cigna of CA PPO |
$2.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: EPIC Health Plan Senior |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$2.42
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$2.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.57
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
|
OP
|
$47.40
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$40.29 |
| Rate for Payer: Adventist Health Commercial |
$9.48
|
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$11.70
|
| Rate for Payer: Blue Shield of California Commercial |
$11.70
|
| Rate for Payer: Blue Shield of California Commercial |
$11.70
|
| Rate for Payer: Blue Shield of California Commercial |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$11.70
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cigna of CA HMO |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA HMO |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$33.18
|
| Rate for Payer: Cigna of CA PPO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$33.18
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: Cigna of CA PPO |
$44.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$32.78
|
| Rate for Payer: Galaxy Health WC |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$40.29
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11.52
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Global Benefits Group Commercial |
$23.14
|
| Rate for Payer: Global Benefits Group Commercial |
$28.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$30.86
|
| Rate for Payer: Multiplan Commercial |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$15.36
|
| Rate for Payer: Networks By Design Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$23.70
|
| Rate for Payer: Networks By Design Commercial |
$19.29
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: Prime Health Services Commercial |
$40.29
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Prime Health Services Commercial |
$16.32
|
| Rate for Payer: Prime Health Services Commercial |
$32.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.79
|
| Rate for Payer: United Healthcare All Other HMO |
$23.01
|
| Rate for Payer: United Healthcare All Other HMO |
$17.32
|
| Rate for Payer: United Healthcare All Other HMO |
$14.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$6.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.94
|
| Rate for Payer: United Healthcare HMO Rider |
$22.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
|
IP
|
$38.57
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$32.78 |
| Rate for Payer: EPIC Health Plan Senior |
$18.96
|
| Rate for Payer: EPIC Health Plan Senior |
$15.43
|
| Rate for Payer: EPIC Health Plan Senior |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$32.78
|
| Rate for Payer: Galaxy Health WC |
$40.29
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11.52
|
| Rate for Payer: Global Benefits Group Commercial |
$28.44
|
| Rate for Payer: Global Benefits Group Commercial |
$23.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$30.86
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$19.29
|
| Rate for Payer: Networks By Design Commercial |
$23.70
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$9.60
|
| Rate for Payer: Prime Health Services Commercial |
$40.29
|
| Rate for Payer: Prime Health Services Commercial |
$16.32
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Prime Health Services Commercial |
$32.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO |
$14.09
|
| Rate for Payer: United Healthcare All Other HMO |
$23.01
|
| Rate for Payer: United Healthcare All Other HMO |
$17.32
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.78
|
| Rate for Payer: United Healthcare HMO Rider |
$6.86
|
| Rate for Payer: United Healthcare HMO Rider |
$22.52
|
| Rate for Payer: United Healthcare HMO Rider |
$16.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.52
|
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Adventist Health Commercial |
$9.48
|
| Rate for Payer: Blue Shield of California Commercial |
$14.17
|
| Rate for Payer: Blue Shield of California Commercial |
$46.49
|
| Rate for Payer: Blue Shield of California Commercial |
$34.98
|
| Rate for Payer: Blue Shield of California Commercial |
$28.46
|
| Rate for Payer: Blue Shield of California EPN |
$9.33
|
| Rate for Payer: Blue Shield of California EPN |
$18.75
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Blue Shield of California EPN |
$30.62
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA HMO |
$33.18
|
| Rate for Payer: Cigna of CA HMO |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$44.10
|
| Rate for Payer: Cigna of CA PPO |
$44.10
|
| Rate for Payer: Cigna of CA PPO |
$33.18
|
| Rate for Payer: Cigna of CA PPO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
|
|
DESMOPRESSIN ORAL SOLUTION COMPOUND 10 MCG/ML [4080400]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 9994-0804-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
DESMOPRESSIN ORAL SOLUTION COMPOUND 10 MCG/ML [4080400]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 9994-0804-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
NDC 51672-1281-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.14
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.57
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
NDC 51672-1281-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
NDC 51672-1281-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
NDC 51672-1281-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.14
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.57
|
|
|
DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 45802-495-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.02
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2.80
|
|
|
DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 45802-495-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [205849]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
NDC 51991-006-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
