|
DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 45802-495-35
|
| Hospital Charge Code |
1743316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$2.80 |
| 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 |
$1.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.96
|
| Rate for Payer: Blue Distinction Transplant |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.48
|
| 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 Media |
$2.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.47
|
| 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: 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
|
| 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 |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| 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 |
1743316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.48
|
| 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: 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: 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
|
|
|
Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 17106
|
| Min. Negotiated Rate |
$498.20 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 59762-1211-3
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
NDC 0008-1211-50
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$11.86 |
| Rate for Payer: Blue Shield of California Commercial |
$9.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.14
|
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: Cigna of CA HMO |
$9.76
|
| Rate for Payer: Cigna of CA PPO |
$9.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$11.86
|
| Rate for Payer: Global Benefits Group Commercial |
$8.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Multiplan Commercial |
$11.16
|
| Rate for Payer: Networks By Design Commercial |
$9.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.86
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$17.52
|
|
|
Service Code
|
NDC 0008-1211-14
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Blue Shield of California Commercial |
$12.47
|
| Rate for Payer: Blue Shield of California EPN |
$8.97
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 59762-1211-3
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: Blue Distinction Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Media |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$17.52
|
|
|
Service Code
|
NDC 0008-1211-14
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.44
|
| Rate for Payer: Blue Distinction Transplant |
$10.51
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California EPN |
$10.23
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.89
|
| Rate for Payer: Dignity Health Media |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.89
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$1.28
|
|
|
Service Code
|
NDC 0054-0400-22
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$17.52
|
|
|
Service Code
|
NDC 0008-1211-30
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Blue Shield of California Commercial |
$12.47
|
| Rate for Payer: Blue Shield of California EPN |
$8.97
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
NDC 0054-0400-13
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: Blue Distinction Transplant |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.09
|
| Rate for Payer: Dignity Health Media |
$1.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.09
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$1.28
|
|
|
Service Code
|
NDC 0054-0400-13
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
NDC 0054-0400-22
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: Blue Distinction Transplant |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.90
|
| Rate for Payer: Cigna of CA PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.09
|
| Rate for Payer: Dignity Health Media |
$1.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.09
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
NDC 0008-1211-50
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$11.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.31
|
| Rate for Payer: Blue Distinction Transplant |
$8.37
|
| Rate for Payer: Blue Shield of California Commercial |
$10.28
|
| Rate for Payer: Blue Shield of California EPN |
$8.15
|
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: Cigna of CA HMO |
$9.76
|
| Rate for Payer: Cigna of CA PPO |
$9.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.86
|
| Rate for Payer: Dignity Health Media |
$11.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$11.86
|
| Rate for Payer: Global Benefits Group Commercial |
$8.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Multiplan Commercial |
$11.16
|
| Rate for Payer: Networks By Design Commercial |
$9.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.86
|
| Rate for Payer: Vantage Medical Group Senior |
$11.86
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$17.52
|
|
|
Service Code
|
NDC 0008-1211-30
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.44
|
| Rate for Payer: Blue Distinction Transplant |
$10.51
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California EPN |
$10.23
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.89
|
| Rate for Payer: Dignity Health Media |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.89
|
|
|
DEXAMETH 1 MG-MOXIFLOX 0.5 MG-KETOROLAC 0.4 MG/ML(PF) INTRAOCULAR SOLN [221697]
|
Facility
|
OP
|
$38.40
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.12
|
| Rate for Payer: Blue Distinction Transplant |
$23.04
|
| Rate for Payer: Blue Shield of California Commercial |
$28.30
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$26.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.64
|
| Rate for Payer: Dignity Health Media |
$32.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.36
|
| Rate for Payer: Galaxy Health WC |
$32.64
|
| Rate for Payer: Global Benefits Group Commercial |
$23.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$30.72
|
| Rate for Payer: Networks By Design Commercial |
$19.20
|
| Rate for Payer: Prime Health Services Commercial |
$32.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.20
|
| Rate for Payer: United Healthcare All Other HMO |
$19.20
|
| Rate for Payer: United Healthcare HMO Rider |
$19.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Vantage Medical Group Senior |
$32.64
|
|
|
DEXAMETH 1 MG-MOXIFLOX 0.5 MG-KETOROLAC 0.4 MG/ML(PF) INTRAOCULAR SOLN [221697]
|
Facility
|
IP
|
$38.40
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Blue Shield of California Commercial |
$27.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.66
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$26.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.36
|
| Rate for Payer: Galaxy Health WC |
$32.64
|
| Rate for Payer: Global Benefits Group Commercial |
$23.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$30.72
|
| Rate for Payer: Networks By Design Commercial |
$19.20
|
| Rate for Payer: Prime Health Services Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.16
|
| Rate for Payer: United Healthcare HMO Rider |
$13.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.67
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
|
OP
|
$4.03
|
|
|
Service Code
|
NDC 61314-294-05
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.40
|
| Rate for Payer: Blue Distinction Transplant |
$2.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.97
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$2.82
|
| Rate for Payer: Cigna of CA PPO |
$2.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.43
|
| Rate for Payer: Dignity Health Media |
$3.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$2.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Commercial |
$3.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.02
|
| Rate for Payer: United Healthcare All Other HMO |
$2.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Vantage Medical Group Senior |
$3.43
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 0998-0615-05
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Blue Shield of California Commercial |
$13.53
|
| Rate for Payer: Blue Shield of California EPN |
$9.73
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO |
$13.30
|
| Rate for Payer: Cigna of CA PPO |
$13.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
|
IP
|
$4.03
|
|
|
Service Code
|
NDC 61314-294-05
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.06
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$2.82
|
| Rate for Payer: Cigna of CA PPO |
$2.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Commercial |
$3.43
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
|
IP
|
$12.94
|
|
|
Service Code
|
NDC 24208-720-02
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9.21
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Networks By Design Commercial |
$8.41
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
|
OP
|
$12.94
|
|
|
Service Code
|
NDC 24208-720-02
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Blue Distinction Transplant |
$7.76
|
| Rate for Payer: Blue Shield of California Commercial |
$9.54
|
| Rate for Payer: Blue Shield of California EPN |
$7.56
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Media |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Networks By Design Commercial |
$8.41
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.00
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 0998-0615-05
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Blue Distinction Transplant |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California EPN |
$11.10
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO |
$13.30
|
| Rate for Payer: Cigna of CA PPO |
$13.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.15
|
| Rate for Payer: Dignity Health Media |
$16.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: Vantage Medical Group Senior |
$16.15
|
|
|
DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION [2320]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1715664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
|
|
DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION [2320]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1715664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
