|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
OP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.01
|
| Rate for Payer: BCBS Transplant Transplant |
$9.08
|
| Rate for Payer: Blue Shield of California Commercial |
$11.15
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$10.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.86
|
| Rate for Payer: Dignity Health Media |
$12.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.05
|
| Rate for Payer: Galaxy Health WC |
$12.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.63
|
| Rate for Payer: Multiplan Commercial |
$12.10
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$12.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.56
|
| Rate for Payer: United Healthcare All Other HMO |
$7.56
|
| Rate for Payer: United Healthcare HMO Rider |
$7.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.86
|
| Rate for Payer: Vantage Medical Group Senior |
$12.86
|
|
|
DEMECLOCYCLINE 300 MG TABLET [9727]
|
Facility
IP
|
$15.13
|
|
|
Service Code
|
NDC 62584-163-11
|
| Hospital Charge Code |
1710010
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Blue Shield of California Commercial |
$10.77
|
| Rate for Payer: Blue Shield of California EPN |
$7.75
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$10.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.05
|
| Rate for Payer: Galaxy Health WC |
$12.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.63
|
| Rate for Payer: Multiplan Commercial |
$12.10
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$12.86
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
OP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$1,792.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$158.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.65
|
| Rate for Payer: BCBS Transplant Transplant |
$1,265.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,554.59
|
| Rate for Payer: Blue Shield of California EPN |
$24.55
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cigna of CA HMO |
$1,476.54
|
| Rate for Payer: Cigna of CA PPO |
$1,476.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: Dignity Health Media |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$1,792.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,265.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,582.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$41.32
|
| Rate for Payer: IEHP Medi-Cal |
$40.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$40.82
|
| Rate for Payer: IEHP Medicare Advantage |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,406.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$1,687.48
|
| Rate for Payer: Networks By Design Commercial |
$1,054.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,792.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,265.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,265.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,054.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,054.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,054.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,054.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [106804]
|
Facility
IP
|
$2,109.35
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$506.24 |
| Max. Negotiated Rate |
$1,792.95 |
| Rate for Payer: Blue Shield of California Commercial |
$1,501.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,079.99
|
| Rate for Payer: Cash Price |
$949.21
|
| Rate for Payer: Cigna of CA HMO |
$1,476.54
|
| Rate for Payer: Cigna of CA PPO |
$1,476.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$843.74
|
| Rate for Payer: Galaxy Health WC |
$1,792.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,265.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,406.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$803.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.24
|
| Rate for Payer: Multiplan Commercial |
$1,687.48
|
| Rate for Payer: Networks By Design Commercial |
$1,054.68
|
| Rate for Payer: Prime Health Services Commercial |
$1,792.95
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
IP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$467.87 |
| Max. Negotiated Rate |
$1,657.03 |
| Rate for Payer: Blue Shield of California Commercial |
$1,388.01
|
| Rate for Payer: Blue Shield of California EPN |
$998.12
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cigna of CA HMO |
$1,364.62
|
| Rate for Payer: Cigna of CA PPO |
$1,364.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$779.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$779.78
|
| Rate for Payer: Galaxy Health WC |
$1,657.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.87
|
| Rate for Payer: Multiplan Commercial |
$1,559.56
|
| Rate for Payer: Networks By Design Commercial |
$974.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.03
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [105502]
|
Facility
OP
|
$1,949.45
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
1755797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$1,657.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$158.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.65
|
| Rate for Payer: BCBS Transplant Transplant |
$1,169.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.74
|
| Rate for Payer: Blue Shield of California EPN |
$24.55
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cigna of CA HMO |
$1,364.62
|
| Rate for Payer: Cigna of CA PPO |
$1,364.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.80
|
| Rate for Payer: Dignity Health Media |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$1,657.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1,169.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,462.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$41.32
|
| Rate for Payer: IEHP Medi-Cal |
$40.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$40.82
|
| Rate for Payer: IEHP Medicare Advantage |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$1,559.56
|
| Rate for Payer: Networks By Design Commercial |
$974.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,169.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,169.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$974.72
|
| Rate for Payer: United Healthcare All Other HMO |
$974.72
|
| Rate for Payer: United Healthcare HMO Rider |
$974.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$974.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.20
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$23,725.36
|
|
|
Service Code
|
APR-DRG 1144
|
| Min. Negotiated Rate |
$18,199.85 |
| Max. Negotiated Rate |
$23,725.36 |
| Rate for Payer: IEHP Medi-Cal |
$18,199.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,725.36
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$6,114.88
|
|
|
Service Code
|
APR-DRG 1141
|
| Min. Negotiated Rate |
$4,690.76 |
| Max. Negotiated Rate |
$6,114.88 |
| Rate for Payer: IEHP Medi-Cal |
$4,690.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,114.88
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$13,556.33
|
|
|
Service Code
|
APR-DRG 1143
|
| Min. Negotiated Rate |
$10,399.13 |
| Max. Negotiated Rate |
$13,556.33 |
| Rate for Payer: IEHP Medi-Cal |
$10,399.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,556.33
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
IP
|
$8,439.90
|
|
|
Service Code
|
APR-DRG 1142
|
| Min. Negotiated Rate |
$6,474.29 |
| Max. Negotiated Rate |
$8,439.90 |
| Rate for Payer: IEHP Medi-Cal |
$6,474.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,439.90
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$5,077.41
|
|
|
Service Code
|
APR-DRG 7541
|
| Min. Negotiated Rate |
$3,894.91 |
| Max. Negotiated Rate |
$5,077.41 |
| Rate for Payer: IEHP Medi-Cal |
$3,894.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,077.41
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$10,777.31
|
|
|
Service Code
|
APR-DRG 7543
|
| Min. Negotiated Rate |
$8,267.33 |
| Max. Negotiated Rate |
$10,777.31 |
| Rate for Payer: IEHP Medi-Cal |
$8,267.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,777.31
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$22,792.51
|
|
|
Service Code
|
APR-DRG 7544
|
| Min. Negotiated Rate |
$17,484.26 |
| Max. Negotiated Rate |
$22,792.51 |
| Rate for Payer: IEHP Medi-Cal |
$17,484.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,792.51
|
|
|
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER
|
Facility
IP
|
$6,792.35
|
|
|
Service Code
|
APR-DRG 7542
|
| Min. Negotiated Rate |
$5,210.45 |
| Max. Negotiated Rate |
$6,792.35 |
| Rate for Payer: IEHP Medi-Cal |
$5,210.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,792.35
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
IP
|
$1.35
|
|
|
Service Code
|
NDC 45963-342-02
|
| Hospital Charge Code |
1710265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
|
|
DESIPRAMINE 25 MG TABLET [2286]
|
Facility
OP
|
$1.35
|
|
|
Service Code
|
NDC 45963-342-02
|
| Hospital Charge Code |
1710265
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: BCBS Transplant Transplant |
$0.81
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.15
|
| Rate for Payer: Dignity Health Media |
$1.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1.15
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
OP
|
$0.88
|
|
|
Service Code
|
NDC 60505-0257-1
|
| Hospital Charge Code |
1711734
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Media |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
DESMOPRESSIN 0.1 MG TABLET [16052]
|
Facility
IP
|
$0.88
|
|
|
Service Code
|
NDC 60505-0257-1
|
| Hospital Charge Code |
1711734
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
IP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| Hospital Charge Code |
1711735
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
|
|
DESMOPRESSIN 0.2 MG TABLET [16053]
|
Facility
OP
|
$0.99
|
|
|
Service Code
|
NDC 60505-0258-1
|
| Hospital Charge Code |
1711735
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.84
|
| Rate for Payer: Dignity Health Media |
$0.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.84
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Vantage Medical Group Senior |
$0.84
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]
|
Facility
IP
|
$47.28
|
|
|
Service Code
|
NDC 24208-342-05
|
| Hospital Charge Code |
NDG27770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Blue Shield of California Commercial |
$33.66
|
| Rate for Payer: Blue Shield of California EPN |
$24.21
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cigna of CA HMO |
$33.10
|
| Rate for Payer: Cigna of CA PPO |
$33.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.91
|
| Rate for Payer: Galaxy Health WC |
$40.19
|
| Rate for Payer: Global Benefits Group Commercial |
$28.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Multiplan Commercial |
$37.82
|
| Rate for Payer: Networks By Design Commercial |
$30.73
|
| Rate for Payer: Prime Health Services Commercial |
$40.19
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]
|
Facility
OP
|
$47.28
|
|
|
Service Code
|
NDC 24208-342-05
|
| Hospital Charge Code |
NDG27770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.17
|
| Rate for Payer: BCBS Transplant Transplant |
$28.37
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Blue Shield of California EPN |
$27.61
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cigna of CA HMO |
$33.10
|
| Rate for Payer: Cigna of CA PPO |
$33.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.19
|
| Rate for Payer: Dignity Health Media |
$40.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.91
|
| Rate for Payer: Galaxy Health WC |
$40.19
|
| Rate for Payer: Global Benefits Group Commercial |
$28.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Multiplan Commercial |
$37.82
|
| Rate for Payer: Networks By Design Commercial |
$30.73
|
| Rate for Payer: Prime Health Services Commercial |
$40.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$28.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO |
$23.64
|
| Rate for Payer: United Healthcare HMO Rider |
$23.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.19
|
| Rate for Payer: Vantage Medical Group Senior |
$40.19
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) [21135]
|
Facility
IP
|
$29.55
|
|
|
Service Code
|
NDC 47335-788-91
|
| Hospital Charge Code |
1740263
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$25.12 |
| Rate for Payer: Blue Shield of California Commercial |
$21.04
|
| Rate for Payer: Blue Shield of California EPN |
$15.13
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$20.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: Galaxy Health WC |
$25.12
|
| Rate for Payer: Global Benefits Group Commercial |
$17.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.09
|
| Rate for Payer: Multiplan Commercial |
$23.64
|
| Rate for Payer: Networks By Design Commercial |
$19.21
|
| Rate for Payer: Prime Health Services Commercial |
$25.12
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) [21135]
|
Facility
OP
|
$29.55
|
|
|
Service Code
|
NDC 47335-788-91
|
| Hospital Charge Code |
1740263
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$25.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.61
|
| Rate for Payer: BCBS Transplant Transplant |
$17.73
|
| Rate for Payer: Blue Shield of California Commercial |
$21.78
|
| Rate for Payer: Blue Shield of California EPN |
$17.26
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$20.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.12
|
| Rate for Payer: Dignity Health Media |
$25.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.82
|
| Rate for Payer: Galaxy Health WC |
$25.12
|
| Rate for Payer: Global Benefits Group Commercial |
$17.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.09
|
| Rate for Payer: Multiplan Commercial |
$23.64
|
| Rate for Payer: Networks By Design Commercial |
$19.21
|
| Rate for Payer: Prime Health Services Commercial |
$25.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$17.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.78
|
| Rate for Payer: United Healthcare All Other HMO |
$14.78
|
| Rate for Payer: United Healthcare HMO Rider |
$14.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.12
|
| Rate for Payer: Vantage Medical Group Senior |
$25.12
|
|
|
DESMOPRESSIN 25 MCG 1/4 TAB [4080522]
|
Facility
OP
|
$3.02
|
|
|
Service Code
|
NDC 9994-0805-22
|
| Hospital Charge Code |
1712429
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: BCBS Transplant Transplant |
$1.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna of CA HMO |
$2.11
|
| Rate for Payer: Cigna of CA PPO |
$2.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.57
|
| Rate for Payer: Dignity Health Media |
$2.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.42
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$2.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.57
|
|
