|
DIABETES
|
Facility
IP
|
$12,962.22
|
|
|
Service Code
|
APR-DRG 4203
|
| Min. Negotiated Rate |
$9,943.39 |
| Max. Negotiated Rate |
$12,962.22 |
| Rate for Payer: IEHP Medi-Cal |
$9,943.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,962.22
|
|
|
DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION [9828]
|
Facility
OP
|
$0.67
|
|
|
Service Code
|
CPT Q9963
|
| Hospital Charge Code |
NDG9828
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: Dignity Health Media |
$0.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION [9828]
|
Facility
IP
|
$0.67
|
|
|
Service Code
|
CPT Q9963
|
| Hospital Charge Code |
NDG9828
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 51079-286-20
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Media |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 0378-0477-01
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 51079-286-01
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 51079-286-01
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Media |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 0378-0477-01
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Media |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 51079-286-20
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
DIAZEPAM 12.5 MG-15 MG-17.5 MG-20 MG RECTAL KIT [87869]
|
Facility
IP
|
$420.90
|
|
|
Service Code
|
NDC 0187-0659-20
|
| Hospital Charge Code |
ERX87869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$101.02 |
| Max. Negotiated Rate |
$357.76 |
| Rate for Payer: Blue Shield of California Commercial |
$299.68
|
| Rate for Payer: Blue Shield of California EPN |
$215.50
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Cigna of CA HMO |
$294.63
|
| Rate for Payer: Cigna of CA PPO |
$294.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.36
|
| Rate for Payer: Galaxy Health WC |
$357.76
|
| Rate for Payer: Global Benefits Group Commercial |
$252.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.02
|
| Rate for Payer: Multiplan Commercial |
$336.72
|
| Rate for Payer: Networks By Design Commercial |
$273.58
|
| Rate for Payer: Prime Health Services Commercial |
$357.76
|
|
|
DIAZEPAM 12.5 MG-15 MG-17.5 MG-20 MG RECTAL KIT [87869]
|
Facility
OP
|
$420.90
|
|
|
Service Code
|
NDC 0187-0659-20
|
| Hospital Charge Code |
ERX87869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$101.02 |
| Max. Negotiated Rate |
$357.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$357.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.77
|
| Rate for Payer: BCBS Transplant Transplant |
$252.54
|
| Rate for Payer: Blue Shield of California Commercial |
$310.20
|
| Rate for Payer: Blue Shield of California EPN |
$245.81
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Cigna of CA HMO |
$294.63
|
| Rate for Payer: Cigna of CA PPO |
$294.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.76
|
| Rate for Payer: Dignity Health Media |
$357.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.36
|
| Rate for Payer: Galaxy Health WC |
$357.76
|
| Rate for Payer: Global Benefits Group Commercial |
$252.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$315.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.02
|
| Rate for Payer: Multiplan Commercial |
$336.72
|
| Rate for Payer: Networks By Design Commercial |
$273.58
|
| Rate for Payer: Prime Health Services Commercial |
$357.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$252.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.45
|
| Rate for Payer: United Healthcare All Other HMO |
$210.45
|
| Rate for Payer: United Healthcare HMO Rider |
$210.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.76
|
| Rate for Payer: Vantage Medical Group Senior |
$357.76
|
|
|
DIAZEPAM 2.5 MG RECTAL KIT [87865]
|
Facility
OP
|
$354.82
|
|
|
Service Code
|
NDC 66490-650-20
|
| Hospital Charge Code |
1748085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$85.16 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: Multiplan Commercial |
$283.86
|
| Rate for Payer: Networks By Design Commercial |
$230.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$301.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$195.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.40
|
| Rate for Payer: BCBS Transplant Transplant |
$212.89
|
| Rate for Payer: Blue Shield of California Commercial |
$261.50
|
| Rate for Payer: Blue Shield of California EPN |
$207.21
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Cigna of CA HMO |
$248.37
|
| Rate for Payer: Cigna of CA PPO |
$248.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$301.60
|
| Rate for Payer: Dignity Health Media |
$301.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$301.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$141.93
|
| Rate for Payer: Galaxy Health WC |
$301.60
|
| Rate for Payer: Global Benefits Group Commercial |
$212.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$266.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.16
|
| Rate for Payer: Prime Health Services Commercial |
$301.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$212.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.41
|
| Rate for Payer: United Healthcare All Other HMO |
$177.41
|
| Rate for Payer: United Healthcare HMO Rider |
$177.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$301.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$301.60
|
| Rate for Payer: Vantage Medical Group Senior |
$301.60
|
|
|
DIAZEPAM 2.5 MG RECTAL KIT [87865]
|
Facility
IP
|
$354.82
|
|
|
Service Code
|
NDC 66490-650-20
|
| Hospital Charge Code |
1748085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$85.16 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: Blue Shield of California Commercial |
$252.63
|
| Rate for Payer: Blue Shield of California EPN |
$181.67
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Cigna of CA HMO |
$248.37
|
| Rate for Payer: Cigna of CA PPO |
$248.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.93
|
| Rate for Payer: Galaxy Health WC |
$301.60
|
| Rate for Payer: Global Benefits Group Commercial |
$212.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$283.86
|
| Rate for Payer: Networks By Design Commercial |
$230.63
|
| Rate for Payer: Prime Health Services Commercial |
$301.60
|
|
|
DIAZEPAM 2 MG TABLET [2404]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 51079-284-01
|
| Hospital Charge Code |
1730080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Media |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
DIAZEPAM 2 MG TABLET [2404]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 51079-284-20
|
| Hospital Charge Code |
1730080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
DIAZEPAM 2 MG TABLET [2404]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 51079-284-01
|
| Hospital Charge Code |
1730080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
DIAZEPAM 2 MG TABLET [2404]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 51079-284-20
|
| Hospital Charge Code |
1730080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Media |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [154274]
|
Facility
OP
|
$0.92
|
|
|
Service Code
|
NDC 68094-750-59
|
| Hospital Charge Code |
NDG154274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: BCBS Transplant Transplant |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: Dignity Health Media |
$0.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.78
|
| Rate for Payer: Vantage Medical Group Senior |
$0.78
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [154274]
|
Facility
IP
|
$0.92
|
|
|
Service Code
|
NDC 68094-750-59
|
| Hospital Charge Code |
NDG154274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.78
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [154274]
|
Facility
IP
|
$0.92
|
|
|
Service Code
|
NDC 68094-750-62
|
| Hospital Charge Code |
NDG154274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.78
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [154274]
|
Facility
OP
|
$0.92
|
|
|
Service Code
|
NDC 68094-750-62
|
| Hospital Charge Code |
NDG154274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: BCBS Transplant Transplant |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: Dignity Health Media |
$0.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.74
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.78
|
| Rate for Payer: Vantage Medical Group Senior |
$0.78
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLUTION [2402]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 0054-3188-63
|
| Hospital Charge Code |
1715521
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Media |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLUTION [2402]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 0054-3188-63
|
| Hospital Charge Code |
1715521
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT [87867]
|
Facility
OP
|
$420.90
|
|
|
Service Code
|
NDC 0187-0658-20
|
| Hospital Charge Code |
1748083
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$101.02 |
| Max. Negotiated Rate |
$357.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$357.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.77
|
| Rate for Payer: BCBS Transplant Transplant |
$252.54
|
| Rate for Payer: Blue Shield of California Commercial |
$310.20
|
| Rate for Payer: Blue Shield of California EPN |
$245.81
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Cigna of CA HMO |
$294.63
|
| Rate for Payer: Cigna of CA PPO |
$294.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.76
|
| Rate for Payer: Dignity Health Media |
$357.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.36
|
| Rate for Payer: Galaxy Health WC |
$357.76
|
| Rate for Payer: Global Benefits Group Commercial |
$252.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$315.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.02
|
| Rate for Payer: Multiplan Commercial |
$336.72
|
| Rate for Payer: Networks By Design Commercial |
$273.58
|
| Rate for Payer: Prime Health Services Commercial |
$357.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$252.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.45
|
| Rate for Payer: United Healthcare All Other HMO |
$210.45
|
| Rate for Payer: United Healthcare HMO Rider |
$210.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.76
|
| Rate for Payer: Vantage Medical Group Senior |
$357.76
|
|
|
DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT [87867]
|
Facility
IP
|
$420.90
|
|
|
Service Code
|
NDC 0187-0658-20
|
| Hospital Charge Code |
1748083
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$101.02 |
| Max. Negotiated Rate |
$357.76 |
| Rate for Payer: EPIC Health Plan Commercial |
$168.36
|
| Rate for Payer: Galaxy Health WC |
$357.76
|
| Rate for Payer: Blue Shield of California Commercial |
$299.68
|
| Rate for Payer: Blue Shield of California EPN |
$215.50
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Cigna of CA HMO |
$294.63
|
| Rate for Payer: Cigna of CA PPO |
$294.63
|
| Rate for Payer: Global Benefits Group Commercial |
$252.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.02
|
| Rate for Payer: Multiplan Commercial |
$336.72
|
| Rate for Payer: Networks By Design Commercial |
$273.58
|
| Rate for Payer: Prime Health Services Commercial |
$357.76
|
|
