|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]
|
Facility
|
OP
|
$11.49
|
|
|
Service Code
|
NDC 0186-4010-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Adventist Health Commercial |
$2.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.06
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cigna of CA HMO |
$8.04
|
| Rate for Payer: Cigna of CA PPO |
$8.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$9.77
|
| Rate for Payer: Global Benefits Group Commercial |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.04
|
| Rate for Payer: Multiplan Commercial |
$9.19
|
| Rate for Payer: Networks By Design Commercial |
$7.47
|
| Rate for Payer: Prime Health Services Commercial |
$9.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.75
|
| Rate for Payer: United Healthcare All Other HMO |
$5.75
|
| Rate for Payer: United Healthcare HMO Rider |
$5.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$9.77
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]
|
Facility
|
IP
|
$11.49
|
|
|
Service Code
|
NDC 0186-4010-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Adventist Health Commercial |
$2.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8.48
|
| Rate for Payer: Blue Shield of California EPN |
$5.58
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cigna of CA HMO |
$8.04
|
| Rate for Payer: Cigna of CA PPO |
$8.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$9.77
|
| Rate for Payer: Global Benefits Group Commercial |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$9.19
|
| Rate for Payer: Networks By Design Commercial |
$7.47
|
| Rate for Payer: Prime Health Services Commercial |
$9.77
|
|
|
ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 61570-074-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California EPN |
$2.19
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
|
|
ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 61570-074-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.83
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
OP
|
$9.73
|
|
|
Service Code
|
NDC 0430-3754-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.27 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.98
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cigna of CA HMO |
$6.81
|
| Rate for Payer: Cigna of CA PPO |
$6.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$8.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: Networks By Design Commercial |
$6.32
|
| Rate for Payer: Prime Health Services Commercial |
$8.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Senior |
$8.27
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
OP
|
$3.07
|
|
|
Service Code
|
NDC 0093-3541-43
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.89
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.00
|
| Rate for Payer: Prime Health Services Commercial |
$2.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.61
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 0093-3541-43
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.27
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.00
|
| Rate for Payer: Prime Health Services Commercial |
$2.61
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
IP
|
$9.73
|
|
|
Service Code
|
NDC 0430-3754-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.27 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.73
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cigna of CA HMO |
$6.81
|
| Rate for Payer: Cigna of CA PPO |
$6.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$8.27
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: Networks By Design Commercial |
$6.32
|
| Rate for Payer: Prime Health Services Commercial |
$8.27
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
|
OP
|
$13.04
|
|
|
Service Code
|
NDC 0781-7129-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.01
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
|
IP
|
$13.04
|
|
|
Service Code
|
NDC 0781-7129-58
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9.62
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
|
IP
|
$13.04
|
|
|
Service Code
|
NDC 0781-7129-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9.62
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
|
OP
|
$13.04
|
|
|
Service Code
|
NDC 0781-7129-58
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.01
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]
|
Facility
|
IP
|
$74.92
|
|
|
Service Code
|
NDC 50419-491-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$63.68 |
| Rate for Payer: Adventist Health Commercial |
$14.98
|
| Rate for Payer: Blue Shield of California Commercial |
$55.29
|
| Rate for Payer: Blue Shield of California EPN |
$36.41
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cigna of CA HMO |
$52.44
|
| Rate for Payer: Cigna of CA PPO |
$52.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.97
|
| Rate for Payer: EPIC Health Plan Senior |
$29.97
|
| Rate for Payer: Galaxy Health WC |
$63.68
|
| Rate for Payer: Global Benefits Group Commercial |
$44.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$59.94
|
| Rate for Payer: Networks By Design Commercial |
$48.70
|
| Rate for Payer: Prime Health Services Commercial |
$63.68
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]
|
Facility
|
OP
|
$74.92
|
|
|
Service Code
|
NDC 50419-491-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$63.68 |
| Rate for Payer: Adventist Health Commercial |
$14.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.01
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cigna of CA HMO |
$52.44
|
| Rate for Payer: Cigna of CA PPO |
$52.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.97
|
| Rate for Payer: EPIC Health Plan Senior |
$29.97
|
| Rate for Payer: Galaxy Health WC |
$63.68
|
| Rate for Payer: Global Benefits Group Commercial |
$44.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$59.94
|
| Rate for Payer: Networks By Design Commercial |
$48.70
|
| Rate for Payer: Prime Health Services Commercial |
$63.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.46
|
| Rate for Payer: United Healthcare All Other HMO |
$37.46
|
| Rate for Payer: United Healthcare HMO Rider |
$37.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.68
|
| Rate for Payer: Vantage Medical Group Senior |
$63.68
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
NDC 0781-7144-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.01
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.09
|
| Rate for Payer: Vantage Medical Group Senior |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
NDC 0781-7144-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9.63
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
NDC 0781-7144-58
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.01
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.09
|
| Rate for Payer: Vantage Medical Group Senior |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
NDC 0781-7144-58
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9.63
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0781-7133-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$16.44
|
| Rate for Payer: Blue Shield of California EPN |
$10.83
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Multiplan Commercial |
$17.82
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0781-7133-58
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$16.44
|
| Rate for Payer: Blue Shield of California EPN |
$10.83
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Multiplan Commercial |
$17.82
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0781-7133-58
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.68
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$17.82
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Vantage Medical Group Senior |
$18.94
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0781-7133-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.68
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$17.82
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Vantage Medical Group Senior |
$18.94
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 65162-228-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$14.44
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Senior |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$15.66
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 65162-228-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$14.44
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Senior |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$15.66
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
NDC 65162-228-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.02
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Senior |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$15.66
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.63
|
|
