|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
IP
|
$0.80
|
|
|
Service Code
|
NDC 59762-1211-3
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
OP
|
$0.80
|
|
|
Service Code
|
NDC 59762-1211-3
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: BCBS Transplant Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Media |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
IP
|
$17.52
|
|
|
Service Code
|
NDC 0008-1211-30
|
| Hospital Charge Code |
ERX91073
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Blue Shield of California Commercial |
$12.47
|
| Rate for Payer: Blue Shield of California EPN |
$8.97
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
|
|
DEXAMETH 1 MG-MOXIFLOX 0.5 MG-KETOROLAC 0.4 MG/ML(PF) INTRAOCULAR SOLN [221697]
|
Facility
IP
|
$38.40
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Blue Shield of California Commercial |
$27.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.66
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$26.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.36
|
| Rate for Payer: Galaxy Health WC |
$32.64
|
| Rate for Payer: Global Benefits Group Commercial |
$23.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$30.72
|
| Rate for Payer: Networks By Design Commercial |
$19.20
|
| Rate for Payer: Prime Health Services Commercial |
$32.64
|
|
|
DEXAMETH 1 MG-MOXIFLOX 0.5 MG-KETOROLAC 0.4 MG/ML(PF) INTRAOCULAR SOLN [221697]
|
Facility
OP
|
$38.40
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.12
|
| Rate for Payer: BCBS Transplant Transplant |
$23.04
|
| Rate for Payer: Blue Shield of California Commercial |
$28.30
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$26.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.64
|
| Rate for Payer: Dignity Health Media |
$32.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.36
|
| Rate for Payer: Galaxy Health WC |
$32.64
|
| Rate for Payer: Global Benefits Group Commercial |
$23.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$30.72
|
| Rate for Payer: Networks By Design Commercial |
$19.20
|
| Rate for Payer: Prime Health Services Commercial |
$32.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.20
|
| Rate for Payer: United Healthcare All Other HMO |
$19.20
|
| Rate for Payer: United Healthcare HMO Rider |
$19.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Vantage Medical Group Senior |
$32.64
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
NDC 0998-0615-05
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: BCBS Transplant Transplant |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California EPN |
$11.10
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO |
$13.30
|
| Rate for Payer: Cigna of CA PPO |
$13.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.15
|
| Rate for Payer: Dignity Health Media |
$16.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: Vantage Medical Group Senior |
$16.15
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
OP
|
$4.03
|
|
|
Service Code
|
NDC 61314-294-05
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.40
|
| Rate for Payer: BCBS Transplant Transplant |
$2.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.97
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$2.82
|
| Rate for Payer: Cigna of CA PPO |
$2.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.43
|
| Rate for Payer: Dignity Health Media |
$3.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$2.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Commercial |
$3.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.02
|
| Rate for Payer: United Healthcare All Other HMO |
$2.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Vantage Medical Group Senior |
$3.43
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
OP
|
$12.94
|
|
|
Service Code
|
NDC 24208-720-02
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: BCBS Transplant Transplant |
$7.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Blue Shield of California Commercial |
$9.54
|
| Rate for Payer: Blue Shield of California EPN |
$7.56
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Media |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Networks By Design Commercial |
$8.41
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.00
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
IP
|
$12.94
|
|
|
Service Code
|
NDC 24208-720-02
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9.21
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Networks By Design Commercial |
$8.41
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
IP
|
$4.03
|
|
|
Service Code
|
NDC 61314-294-05
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.06
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$2.82
|
| Rate for Payer: Cigna of CA PPO |
$2.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Commercial |
$3.43
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
IP
|
$19.00
|
|
|
Service Code
|
NDC 0998-0615-05
|
| Hospital Charge Code |
1740106
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Blue Shield of California Commercial |
$13.53
|
| Rate for Payer: Blue Shield of California EPN |
$9.73
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO |
$13.30
|
| Rate for Payer: Cigna of CA PPO |
$13.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
|
|
DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION [2320]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1715664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION [2320]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1715664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
DEXAMETHASONE 0.5 MG TABLET [2322]
|
Facility
OP
|
$0.21
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1710096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: Dignity Health Media |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
DEXAMETHASONE 0.5 MG TABLET [2322]
|
Facility
IP
|
$0.21
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1710096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
|
DEXAMETHASONE 10 MG/ML MED NEB SOLUTION [192189]
|
Facility
IP
|
$1.72
|
|
|
Service Code
|
NDC 0641-0367-21
|
| Hospital Charge Code |
1730171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
DEXAMETHASONE 10 MG/ML MED NEB SOLUTION [192189]
|
Facility
OP
|
$1.72
|
|
|
Service Code
|
NDC 0641-0367-21
|
| Hospital Charge Code |
1730171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.02
|
| Rate for Payer: BCBS Transplant Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Media |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
DEXAMETHASONE 10 MG/ML SUBCONJUNCTIVAL INJECTION [4081910]
|
Facility
IP
|
$1.72
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1730171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
DEXAMETHASONE 10 MG/ML SUBCONJUNCTIVAL INJECTION [4081910]
|
Facility
OP
|
$1.86
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: BCBS Transplant Transplant |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.58
|
| Rate for Payer: Dignity Health Media |
$1.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1.58
|
|
|
DEXAMETHASONE 10 MG/ML SUBCONJUNCTIVAL INJECTION [4081910]
|
Facility
OP
|
$1.72
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1730171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: BCBS Transplant Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Media |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
DEXAMETHASONE 10 MG/ML SUBCONJUNCTIVAL INJECTION [4081910]
|
Facility
IP
|
$1.86
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.58
|
|
|
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE) [110922]
|
Facility
IP
|
$0.95
|
|
|
Service Code
|
NDC 0054-3176-44
|
| Hospital Charge Code |
1715988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
|
|
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE) [110922]
|
Facility
OP
|
$0.95
|
|
|
Service Code
|
NDC 0054-3176-44
|
| Hospital Charge Code |
1715988
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.57
|
| Rate for Payer: BCBS Transplant Transplant |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.81
|
| Rate for Payer: Dignity Health Media |
$0.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.81
|
| Rate for Payer: Global Benefits Group Commercial |
$0.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Vantage Medical Group Senior |
$0.81
|
|
|
DEXAMETHASONE 1 MG-MOXIFLOXACIN 5 MG/ML (PF)-NACL,ISO INTRAOCULAR SOLN [221704]
|
Facility
IP
|
$34.80
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221704
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$29.58 |
| Rate for Payer: Blue Shield of California Commercial |
$24.78
|
| Rate for Payer: Blue Shield of California EPN |
$17.82
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$24.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.92
|
| Rate for Payer: Galaxy Health WC |
$29.58
|
| Rate for Payer: Global Benefits Group Commercial |
$20.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.35
|
| Rate for Payer: Multiplan Commercial |
$27.84
|
| Rate for Payer: Networks By Design Commercial |
$17.40
|
| Rate for Payer: Prime Health Services Commercial |
$29.58
|
|
|
DEXAMETHASONE 1 MG-MOXIFLOXACIN 5 MG/ML (PF)-NACL,ISO INTRAOCULAR SOLN [221704]
|
Facility
OP
|
$34.80
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221704
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$29.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.14
|
| Rate for Payer: BCBS Transplant Transplant |
$20.88
|
| Rate for Payer: Blue Shield of California Commercial |
$25.65
|
| Rate for Payer: Blue Shield of California EPN |
$20.32
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$24.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.58
|
| Rate for Payer: Dignity Health Media |
$29.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.92
|
| Rate for Payer: Galaxy Health WC |
$29.58
|
| Rate for Payer: Global Benefits Group Commercial |
$20.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.35
|
| Rate for Payer: Multiplan Commercial |
$27.84
|
| Rate for Payer: Networks By Design Commercial |
$17.40
|
| Rate for Payer: Prime Health Services Commercial |
$29.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.40
|
| Rate for Payer: United Healthcare All Other HMO |
$17.40
|
| Rate for Payer: United Healthcare HMO Rider |
$17.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.58
|
| Rate for Payer: Vantage Medical Group Senior |
$29.58
|
|
