|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 59651-719-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 43547-634-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| 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 |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 0832-6053-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| 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 |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| 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 |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]
|
Facility
|
OP
|
$14.76
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$95.08 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.08
|
| Rate for Payer: Blue Shield of California Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California EPN |
$42.00
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cigna of CA HMO |
$10.33
|
| Rate for Payer: Cigna of CA PPO |
$10.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.33
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5.39
|
| Rate for Payer: United Healthcare HMO Rider |
$5.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.55
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]
|
Facility
|
IP
|
$14.76
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Blue Shield of California Commercial |
$10.89
|
| Rate for Payer: Blue Shield of California EPN |
$7.17
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cigna of CA HMO |
$10.33
|
| Rate for Payer: Cigna of CA PPO |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5.39
|
| Rate for Payer: United Healthcare HMO Rider |
$5.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.83
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 60687-380-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 0904-6988-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| 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 |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| 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 |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
| 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 |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 60687-380-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 60687-380-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 0904-6988-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| 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 |
$0.33
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| 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 |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 0591-0795-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 0591-0795-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 60687-380-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION [9853]
|
Facility
|
IP
|
$165.28
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$140.49 |
| Rate for Payer: Adventist Health Commercial |
$33.06
|
| Rate for Payer: Blue Shield of California Commercial |
$121.98
|
| Rate for Payer: Blue Shield of California EPN |
$80.33
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$115.70
|
| Rate for Payer: Cigna of CA PPO |
$115.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.11
|
| Rate for Payer: EPIC Health Plan Senior |
$66.11
|
| Rate for Payer: Galaxy Health WC |
$140.49
|
| Rate for Payer: Global Benefits Group Commercial |
$99.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.67
|
| Rate for Payer: Multiplan Commercial |
$132.22
|
| Rate for Payer: Networks By Design Commercial |
$82.64
|
| Rate for Payer: Prime Health Services Commercial |
$140.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.03
|
| Rate for Payer: United Healthcare All Other HMO |
$60.38
|
| Rate for Payer: United Healthcare HMO Rider |
$59.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.13
|
|
|
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION [9853]
|
Facility
|
OP
|
$165.28
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$140.49 |
| Rate for Payer: Cigna of CA PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.11
|
| Rate for Payer: EPIC Health Plan Senior |
$66.11
|
| Rate for Payer: Galaxy Health WC |
$140.49
|
| Rate for Payer: Global Benefits Group Commercial |
$99.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$115.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$115.70
|
| Rate for Payer: Multiplan Commercial |
$132.22
|
| Rate for Payer: Networks By Design Commercial |
$82.64
|
| Rate for Payer: Prime Health Services Commercial |
$140.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.03
|
| Rate for Payer: United Healthcare All Other HMO |
$60.38
|
| Rate for Payer: United Healthcare HMO Rider |
$59.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$140.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.49
|
| Rate for Payer: Vantage Medical Group Senior |
$140.49
|
| Rate for Payer: Adventist Health Commercial |
$33.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$140.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$115.70
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 0143-1240-01
|
| 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
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 10135-747-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5921-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Senior |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.07
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.87
|
| Rate for Payer: United Healthcare HMO Rider |
$0.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
NDC 60687-858-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1.24
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
NDC 60687-858-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 10135-747-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.07
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.87
|
| Rate for Payer: United Healthcare HMO Rider |
$0.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
|
