|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.42
|
|
|
Service Code
|
NDC 0143-1240-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.99
|
| Rate for Payer: Cigna of CA PPO |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.21
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5921-61
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
IP
|
$1.39
|
|
|
Service Code
|
NDC 60687-551-11
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
OP
|
$1.39
|
|
|
Service Code
|
NDC 60687-551-11
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.83
|
| Rate for Payer: BCBS Transplant Transplant |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.97
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.18
|
| Rate for Payer: Dignity Health Media |
$1.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1.18
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
OP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5922-61
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: BCBS Transplant Transplant |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Media |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
IP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5922-61
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.38
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [110919]
|
Facility
OP
|
$75.82
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$64.45 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2.80
|
| Rate for Payer: Vantage Medical Group Senior |
$64.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.73
|
| Rate for Payer: BCBS Transplant Transplant |
$1.98
|
| Rate for Payer: BCBS Transplant Transplant |
$45.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$55.88
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Cigna of CA HMO |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$53.07
|
| Rate for Payer: Cigna of CA PPO |
$53.07
|
| Rate for Payer: Cigna of CA PPO |
$2.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.45
|
| Rate for Payer: Dignity Health Media |
$2.80
|
| Rate for Payer: Dignity Health Media |
$64.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$64.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$45.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$56.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$60.66
|
| Rate for Payer: Networks By Design Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$37.91
|
| Rate for Payer: Prime Health Services Commercial |
$64.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1.65
|
| Rate for Payer: United Healthcare All Other HMO |
$37.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1.65
|
| Rate for Payer: United Healthcare HMO Rider |
$37.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.80
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [110919]
|
Facility
IP
|
$3.30
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Blue Shield of California Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$53.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Blue Shield of California EPN |
$38.82
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Cigna of CA HMO |
$53.07
|
| Rate for Payer: Cigna of CA HMO |
$2.31
|
| Rate for Payer: Cigna of CA PPO |
$53.07
|
| Rate for Payer: Cigna of CA PPO |
$2.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.33
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$64.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.98
|
| Rate for Payer: Global Benefits Group Commercial |
$45.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$60.66
|
| Rate for Payer: Multiplan Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$37.91
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
| Rate for Payer: Prime Health Services Commercial |
$64.45
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]
|
Facility
OP
|
$2.80
|
|
|
Service Code
|
NDC 0054-0057-46
|
| Hospital Charge Code |
1715678
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.67
|
| Rate for Payer: BCBS Transplant Transplant |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.96
|
| Rate for Payer: Cigna of CA PPO |
$1.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.38
|
| Rate for Payer: Dignity Health Media |
$2.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Commercial |
$2.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2.38
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]
|
Facility
IP
|
$2.80
|
|
|
Service Code
|
NDC 0054-0057-46
|
| Hospital Charge Code |
1715678
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.96
|
| Rate for Payer: Cigna of CA PPO |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Commercial |
$2.38
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]
|
Facility
IP
|
$5,518.80
|
|
|
Service Code
|
CPT J1162
|
| Hospital Charge Code |
1712460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,324.51 |
| Max. Negotiated Rate |
$4,690.98 |
| Rate for Payer: Blue Shield of California Commercial |
$3,929.39
|
| Rate for Payer: Blue Shield of California EPN |
$2,825.63
|
| Rate for Payer: Cash Price |
$2,483.46
|
| Rate for Payer: Cigna of CA HMO |
$3,863.16
|
| Rate for Payer: Cigna of CA PPO |
$3,863.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,207.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,207.52
|
| Rate for Payer: Galaxy Health WC |
$4,690.98
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,681.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,102.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.51
|
| Rate for Payer: Multiplan Commercial |
$4,415.04
|
| Rate for Payer: Networks By Design Commercial |
$2,759.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,690.98
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]
|
Facility
OP
|
$5,518.80
|
|
|
Service Code
|
CPT J1162
|
| Hospital Charge Code |
1712460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,324.51 |
| Max. Negotiated Rate |
$30,047.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,047.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,971.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,255.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,255.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,346.84
|
| Rate for Payer: BCBS Transplant Transplant |
$3,311.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,067.36
|
| Rate for Payer: Blue Shield of California EPN |
$4,768.80
|
| Rate for Payer: Cash Price |
$2,483.46
|
| Rate for Payer: Cash Price |
$2,483.46
|
| Rate for Payer: Cigna of CA HMO |
$3,863.16
|
| Rate for Payer: Cigna of CA PPO |
$3,863.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,166.16
|
| Rate for Payer: Dignity Health Media |
$4,777.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,255.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,449.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,777.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,777.44
|
| Rate for Payer: Galaxy Health WC |
$4,690.98
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,139.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,835.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,835.00
|
| Rate for Payer: IEHP Medi-Cal |
$7,739.45
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,739.45
|
| Rate for Payer: IEHP Medicare Advantage |
$4,777.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,681.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,085.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,777.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,019.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,401.77
|
| Rate for Payer: Multiplan Commercial |
$4,415.04
|
| Rate for Payer: Networks By Design Commercial |
$2,759.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,690.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,311.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,311.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,759.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,759.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,759.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,759.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,166.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,255.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,777.44
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]
|
Facility
IP
|
$101.05
|
|
|
Service Code
|
CPT J1110
|
| Hospital Charge Code |
1720065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$85.89 |
| Rate for Payer: Blue Shield of California Commercial |
$71.95
|
| Rate for Payer: Blue Shield of California EPN |
$51.74
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Cigna of CA HMO |
$70.74
|
| Rate for Payer: Cigna of CA PPO |
$70.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.42
|
| Rate for Payer: Galaxy Health WC |
$85.89
|
| Rate for Payer: Global Benefits Group Commercial |
$60.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Multiplan Commercial |
$80.84
|
| Rate for Payer: Networks By Design Commercial |
$50.52
|
| Rate for Payer: Prime Health Services Commercial |
$85.89
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]
|
Facility
OP
|
$101.05
|
|
|
Service Code
|
CPT J1110
|
| Hospital Charge Code |
1720065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$266.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$266.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.13
|
| Rate for Payer: BCBS Transplant Transplant |
$60.63
|
| Rate for Payer: Blue Shield of California Commercial |
$74.47
|
| Rate for Payer: Blue Shield of California EPN |
$149.74
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Cigna of CA HMO |
$70.74
|
| Rate for Payer: Cigna of CA PPO |
$70.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.89
|
| Rate for Payer: Dignity Health Media |
$85.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.42
|
| Rate for Payer: Galaxy Health WC |
$85.89
|
| Rate for Payer: Global Benefits Group Commercial |
$60.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Multiplan Commercial |
$80.84
|
| Rate for Payer: Networks By Design Commercial |
$50.52
|
| Rate for Payer: Prime Health Services Commercial |
$85.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.52
|
| Rate for Payer: United Healthcare All Other HMO |
$50.52
|
| Rate for Payer: United Healthcare HMO Rider |
$50.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.89
|
| Rate for Payer: Vantage Medical Group Senior |
$85.89
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
IP
|
$10,555.64
|
|
|
Service Code
|
APR-DRG 5171
|
| Min. Negotiated Rate |
$8,097.29 |
| Max. Negotiated Rate |
$10,555.64 |
| Rate for Payer: IEHP Medi-Cal |
$8,097.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,555.64
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
IP
|
$13,398.50
|
|
|
Service Code
|
APR-DRG 5172
|
| Min. Negotiated Rate |
$10,278.06 |
| Max. Negotiated Rate |
$13,398.50 |
| Rate for Payer: IEHP Medi-Cal |
$10,278.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,398.50
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
IP
|
$22,489.26
|
|
|
Service Code
|
APR-DRG 5173
|
| Min. Negotiated Rate |
$17,251.63 |
| Max. Negotiated Rate |
$22,489.26 |
| Rate for Payer: IEHP Medi-Cal |
$17,251.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,489.26
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
IP
|
$39,557.03
|
|
|
Service Code
|
APR-DRG 5174
|
| Min. Negotiated Rate |
$30,344.41 |
| Max. Negotiated Rate |
$39,557.03 |
| Rate for Payer: IEHP Medi-Cal |
$30,344.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,557.03
|
|
|
DILTIAZEM 30 MG TABLET [2475]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 68682-006-10
|
| Hospital Charge Code |
1712032
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| 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 |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
DILTIAZEM 30 MG TABLET [2475]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 0093-0318-01
|
| Hospital Charge Code |
1712032
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
DILTIAZEM 30 MG TABLET [2475]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 0093-0318-01
|
| Hospital Charge Code |
1712032
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Media |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
DILTIAZEM 30 MG TABLET [2475]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 68682-006-10
|
| Hospital Charge Code |
1712032
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| 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 |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| 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 |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97253]
|
Facility
OP
|
$0.78
|
|
|
Service Code
|
NDC 70860-301-41
|
| Hospital Charge Code |
1722001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Media |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| 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 |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION [97253]
|
Facility
OP
|
$0.78
|
|
|
Service Code
|
NDC 70860-301-05
|
| Hospital Charge Code |
1722001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Media |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| 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 |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
