|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1730171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Blue Distinction Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Media |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]
|
Facility
|
IP
|
$1.72
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1730171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$1.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.69
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| 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 |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Blue Distinction Transplant |
$2.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.70
|
| Rate for Payer: Blue Distinction Transplant |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: Dignity Health Media |
$0.99
|
| Rate for Payer: Dignity Health Media |
$0.79
|
| Rate for Payer: Dignity Health Media |
$2.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Vantage Medical Group Senior |
$2.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.79
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.65
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$2.94
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$2.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SYRINGE [114048]
|
Facility
|
OP
|
$3.47
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG114048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Blue Distinction Transplant |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$2.43
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.95
|
| Rate for Payer: Dignity Health Media |
$2.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2.95
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SYRINGE [114048]
|
Facility
|
IP
|
$3.47
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG114048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$2.43
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [118427]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG118427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Blue Distinction Transplant |
$3.17
|
| Rate for Payer: Blue Distinction Transplant |
$1.26
|
| Rate for Payer: Blue Distinction Transplant |
$5.40
|
| Rate for Payer: Blue Distinction Transplant |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California Commercial |
$6.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Media |
$7.65
|
| Rate for Payer: Dignity Health Media |
$1.78
|
| Rate for Payer: Dignity Health Media |
$4.49
|
| Rate for Payer: Dignity Health Media |
$5.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Galaxy Health WC |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$5.03
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$3.14
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$5.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [118427]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG118427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California Commercial |
$6.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4.48
|
| Rate for Payer: Blue Shield of California EPN |
$4.61
|
| Rate for Payer: Blue Shield of California EPN |
$2.70
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$5.03
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$3.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.74
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE [225593]
|
Facility
|
IP
|
$6.94
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG225593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: Blue Shield of California Commercial |
$4.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.55
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cigna of CA HMO |
$4.86
|
| Rate for Payer: Cigna of CA PPO |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$3.47
|
| Rate for Payer: Prime Health Services Commercial |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.29
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE [225593]
|
Facility
|
OP
|
$6.94
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG225593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Blue Distinction Transplant |
$4.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cigna of CA HMO |
$4.86
|
| Rate for Payer: Cigna of CA PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Media |
$5.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.55
|
| Rate for Payer: Networks By Design Commercial |
$3.47
|
| Rate for Payer: Prime Health Services Commercial |
$5.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5.90
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
NDC 70860-605-03
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.76
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
IP
|
$7.80
|
|
|
Service Code
|
NDC 0143-9532-25
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Blue Shield of California Commercial |
$5.55
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.07
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 71288-505-03
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 71288-505-02
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: Blue Distinction Transplant |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$2.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.75
|
| Rate for Payer: Dignity Health Media |
$2.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2.75
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
OP
|
$7.80
|
|
|
Service Code
|
NDC 0143-9532-25
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.65
|
| Rate for Payer: Blue Distinction Transplant |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$4.56
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: Dignity Health Media |
$6.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.07
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
OP
|
$7.80
|
|
|
Service Code
|
NDC 0143-9532-01
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.65
|
| Rate for Payer: Blue Distinction Transplant |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$4.56
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: Dignity Health Media |
$6.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.07
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
IP
|
$7.80
|
|
|
Service Code
|
NDC 0143-9532-01
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Blue Shield of California Commercial |
$5.55
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$5.07
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
NDC 70860-605-03
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: Blue Distinction Transplant |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.90
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$2.08
|
| Rate for Payer: Cigna of CA PPO |
$2.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.76
|
| Rate for Payer: Dignity Health Media |
$2.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.76
|
| Rate for Payer: Vantage Medical Group Senior |
$2.76
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 71288-505-03
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: Blue Distinction Transplant |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$2.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.75
|
| Rate for Payer: Dignity Health Media |
$2.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2.75
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 55150-209-02
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Blue Distinction Transplant |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$2.76
|
| Rate for Payer: Cigna of CA PPO |
$3.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 71288-505-02
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
NDC 70860-605-41
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.76
|
|
