|
ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [35639]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
CPT J1805
|
| Hospital Charge Code |
1759130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$8.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.14
|
| Rate for Payer: Blue Distinction Transplant |
$1.15
|
| Rate for Payer: Blue Distinction Transplant |
$1.08
|
| Rate for Payer: Blue Distinction Transplant |
$3.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.53
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$5.14
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$3.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$0.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$0.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$0.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Prime Health Services Commercial |
$5.14
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.96
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [35639]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
CPT J1805
|
| Hospital Charge Code |
1759130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$4.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$5.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$3.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Prime Health Services Commercial |
$5.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.23
|
| Rate for Payer: United Healthcare HMO Rider |
$2.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.00
|
|
|
ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN STERILE WATER INTRAVENOUS SOLN [221109]
|
Facility
|
OP
|
$1.55
|
|
|
Service Code
|
CPT J1806
|
| Hospital Charge Code |
NDG221109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Blue Distinction Transplant |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Media |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$0.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
ESMOLOL 2,000 MG/100 ML (20 MG/ML) IN STERILE WATER INTRAVENOUS SOLN [221109]
|
Facility
|
IP
|
$1.55
|
|
|
Service Code
|
CPT J1806
|
| Hospital Charge Code |
NDG221109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
CPT J1805
|
| Hospital Charge Code |
1759131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]
|
Facility
|
OP
|
$1.55
|
|
|
Service Code
|
CPT J1805
|
| Hospital Charge Code |
1759131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$8.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: Blue Distinction Transplant |
$0.93
|
| Rate for Payer: Blue Distinction Transplant |
$0.47
|
| Rate for Payer: Blue Distinction Transplant |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$0.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$0.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$0.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$0.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]
|
Facility
|
IP
|
$11.01
|
|
|
Service Code
|
NDC 0186-5020-54
|
| Hospital Charge Code |
1711865
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Blue Shield of California Commercial |
$7.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.64
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$7.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.16
|
| Rate for Payer: Prime Health Services Commercial |
$9.36
|
|
|
ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE [29745]
|
Facility
|
OP
|
$11.01
|
|
|
Service Code
|
NDC 0186-5020-54
|
| Hospital Charge Code |
1711865
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.56
|
| Rate for Payer: Blue Distinction Transplant |
$6.61
|
| Rate for Payer: Blue Shield of California Commercial |
$8.11
|
| Rate for Payer: Blue Shield of California EPN |
$6.43
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$7.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.36
|
| Rate for Payer: Dignity Health Media |
$9.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.16
|
| Rate for Payer: Prime Health Services Commercial |
$9.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.36
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]
|
Facility
|
OP
|
$11.01
|
|
|
Service Code
|
NDC 0186-5040-54
|
| Hospital Charge Code |
1711866
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.56
|
| Rate for Payer: Blue Distinction Transplant |
$6.61
|
| Rate for Payer: Blue Shield of California Commercial |
$8.11
|
| Rate for Payer: Blue Shield of California EPN |
$6.43
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$7.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.36
|
| Rate for Payer: Dignity Health Media |
$9.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.16
|
| Rate for Payer: Prime Health Services Commercial |
$9.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.36
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE [29746]
|
Facility
|
IP
|
$11.01
|
|
|
Service Code
|
NDC 0186-5040-54
|
| Hospital Charge Code |
1711866
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Blue Shield of California Commercial |
$7.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.64
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$7.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.36
|
| Rate for Payer: Global Benefits Group Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.16
|
| Rate for Payer: Prime Health Services Commercial |
$9.36
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]
|
Facility
|
IP
|
$11.49
|
|
|
Service Code
|
NDC 0186-4010-01
|
| Hospital Charge Code |
ERX91031
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Blue Shield of California EPN |
$5.88
|
| Rate for Payer: Cash Price |
$5.17
|
| 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: 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: 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
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]
|
Facility
|
OP
|
$11.49
|
|
|
Service Code
|
NDC 0186-4010-01
|
| Hospital Charge Code |
ERX91031
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$9.77 |
| 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 |
$6.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.85
|
| Rate for Payer: Blue Distinction Transplant |
$6.89
|
| Rate for Payer: Blue Shield of California Commercial |
$8.47
|
| Rate for Payer: Blue Shield of California EPN |
$6.71
|
| Rate for Payer: Cash Price |
$5.17
|
| 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 Media |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$9.77
|
| Rate for Payer: Global Benefits Group Commercial |
$6.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.62
|
| 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: 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
|
| 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 |
$5.74
|
| Rate for Payer: United Healthcare All Other HMO |
$5.74
|
| Rate for Payer: United Healthcare HMO Rider |
$5.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.74
|
| 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 SODIUM 40 MG INTRAVENOUS SOLUTION [41174]
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
CPT C9113
|
| Hospital Charge Code |
1722037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: Blue Shield of California Commercial |
$38.15
|
| Rate for Payer: Blue Shield of California EPN |
$27.43
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cigna of CA HMO |
$37.51
|
| Rate for Payer: Cigna of CA PPO |
$37.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.43
|
| Rate for Payer: Galaxy Health WC |
$45.54
|
| Rate for Payer: Global Benefits Group Commercial |
$32.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$42.86
|
| Rate for Payer: Networks By Design Commercial |
$26.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.23
|
| Rate for Payer: United Healthcare All Other HMO |
$19.76
|
| Rate for Payer: United Healthcare HMO Rider |
$19.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
|
|
ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION [41174]
|
Facility
|
OP
|
$53.58
|
|
|
Service Code
|
CPT C9113
|
| Hospital Charge Code |
1722037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$63.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.69
|
| Rate for Payer: Blue Distinction Transplant |
$32.15
|
| Rate for Payer: Blue Shield of California Commercial |
$39.49
|
| Rate for Payer: Blue Shield of California EPN |
$31.29
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cigna of CA HMO |
$37.51
|
| Rate for Payer: Cigna of CA PPO |
$37.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.54
|
| Rate for Payer: Dignity Health Media |
$45.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.43
|
| Rate for Payer: Galaxy Health WC |
$45.54
|
| Rate for Payer: Global Benefits Group Commercial |
$32.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$42.86
|
| Rate for Payer: Networks By Design Commercial |
$26.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.79
|
| Rate for Payer: United Healthcare All Other HMO |
$26.79
|
| Rate for Payer: United Healthcare HMO Rider |
$26.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.54
|
| Rate for Payer: Vantage Medical Group Senior |
$45.54
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)
|
Facility
|
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 43249
|
| Min. Negotiated Rate |
$423.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Esophagoscopy, flexible, transoral; with removal of foreign body(s)
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 43215
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)
|
Facility
|
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 43220
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 43191
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 61570-074-01
|
| Hospital Charge Code |
1712371
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.63
|
| Rate for Payer: Blue Distinction Transplant |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Media |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3.75
|
|
|
ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 61570-074-01
|
| Hospital Charge Code |
1712371
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
OP
|
$9.74
|
|
|
Service Code
|
NDC 0430-3754-14
|
| Hospital Charge Code |
1743763
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.80
|
| Rate for Payer: Blue Distinction Transplant |
$5.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7.18
|
| Rate for Payer: Blue Shield of California EPN |
$5.69
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO |
$6.82
|
| Rate for Payer: Cigna of CA PPO |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.28
|
| Rate for Payer: Dignity Health Media |
$8.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.79
|
| Rate for Payer: Networks By Design Commercial |
$6.33
|
| Rate for Payer: Prime Health Services Commercial |
$8.28
|
| 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 |
$8.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.28
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
OP
|
$3.07
|
|
|
Service Code
|
NDC 0093-3541-43
|
| Hospital Charge Code |
1743763
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.61 |
| 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 |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: Blue Distinction Transplant |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.38
|
| 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 Media |
$2.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.30
|
| 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: 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
|
| 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 |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.54
|
| 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
|
$9.74
|
|
|
Service Code
|
NDC 0430-3754-14
|
| Hospital Charge Code |
1743763
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Blue Shield of California Commercial |
$6.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.99
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO |
$6.82
|
| Rate for Payer: Cigna of CA PPO |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.79
|
| Rate for Payer: Networks By Design Commercial |
$6.33
|
| Rate for Payer: Prime Health Services Commercial |
$8.28
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 0093-3541-43
|
| Hospital Charge Code |
1743763
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$1.38
|
| 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: 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: 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 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
|
OP
|
$13.04
|
|
|
Service Code
|
NDC 0781-7129-58
|
| Hospital Charge Code |
1743733
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.08 |
| 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 |
$7.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.77
|
| Rate for Payer: Blue Distinction Transplant |
$7.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9.61
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$5.87
|
| 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 Media |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.78
|
| 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: 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
|
| 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
|
|
