|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]
|
Facility
IP
|
$11.49
|
|
|
Service Code
|
NDC 0186-4010-01
|
| Hospital Charge Code |
ERX91031
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Blue Shield of California EPN |
$5.88
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cigna of CA HMO |
$8.04
|
| Rate for Payer: Cigna of CA PPO |
$8.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$9.77
|
| Rate for Payer: Global Benefits Group Commercial |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$9.19
|
| Rate for Payer: Networks By Design Commercial |
$7.47
|
| Rate for Payer: Prime Health Services Commercial |
$9.77
|
|
|
ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION [41174]
|
Facility
IP
|
$53.58
|
|
|
Service Code
|
CPT C9113
|
| Hospital Charge Code |
1722037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: Blue Shield of California Commercial |
$38.15
|
| Rate for Payer: Blue Shield of California EPN |
$27.43
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cigna of CA HMO |
$37.51
|
| Rate for Payer: Cigna of CA PPO |
$37.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.43
|
| Rate for Payer: Galaxy Health WC |
$45.54
|
| Rate for Payer: Global Benefits Group Commercial |
$32.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$42.86
|
| Rate for Payer: Networks By Design Commercial |
$26.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.54
|
|
|
ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION [41174]
|
Facility
OP
|
$53.58
|
|
|
Service Code
|
CPT C9113
|
| Hospital Charge Code |
1722037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$63.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.69
|
| Rate for Payer: BCBS Transplant Transplant |
$32.15
|
| Rate for Payer: Blue Shield of California Commercial |
$39.49
|
| Rate for Payer: Blue Shield of California EPN |
$31.29
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Cigna of CA HMO |
$37.51
|
| Rate for Payer: Cigna of CA PPO |
$37.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.54
|
| Rate for Payer: Dignity Health Media |
$45.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.43
|
| Rate for Payer: Galaxy Health WC |
$45.54
|
| Rate for Payer: Global Benefits Group Commercial |
$32.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$42.86
|
| Rate for Payer: Networks By Design Commercial |
$26.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.79
|
| Rate for Payer: United Healthcare All Other HMO |
$26.79
|
| Rate for Payer: United Healthcare HMO Rider |
$26.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.54
|
| Rate for Payer: Vantage Medical Group Senior |
$45.54
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)
|
Facility
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 43249
|
| Min. Negotiated Rate |
$423.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Esophagoscopy, flexible, transoral; with removal of foreign body(s)
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 43215
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)
|
Facility
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 43220
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 43191
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Esophagoscopy, rigid, transoral; with removal of foreign body(s)
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 43194
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]
|
Facility
OP
|
$4.41
|
|
|
Service Code
|
NDC 61570-074-01
|
| Hospital Charge Code |
1712371
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.63
|
| Rate for Payer: BCBS Transplant Transplant |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Media |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3.75
|
|
|
ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]
|
Facility
IP
|
$4.41
|
|
|
Service Code
|
NDC 61570-074-01
|
| Hospital Charge Code |
1712371
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
IP
|
$9.74
|
|
|
Service Code
|
NDC 0430-3754-14
|
| Hospital Charge Code |
1743763
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Blue Shield of California Commercial |
$6.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.99
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO |
$6.82
|
| Rate for Payer: Cigna of CA PPO |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.79
|
| Rate for Payer: Networks By Design Commercial |
$6.33
|
| Rate for Payer: Prime Health Services Commercial |
$8.28
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
IP
|
$3.07
|
|
|
Service Code
|
NDC 0093-3541-43
|
| Hospital Charge Code |
1743763
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.00
|
| Rate for Payer: Prime Health Services Commercial |
$2.61
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
OP
|
$9.74
|
|
|
Service Code
|
NDC 0430-3754-14
|
| Hospital Charge Code |
1743763
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.80
|
| Rate for Payer: BCBS Transplant Transplant |
$5.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7.18
|
| Rate for Payer: Blue Shield of California EPN |
$5.69
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO |
$6.82
|
| Rate for Payer: Cigna of CA PPO |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.28
|
| Rate for Payer: Dignity Health Media |
$8.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$5.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.79
|
| Rate for Payer: Networks By Design Commercial |
$6.33
|
| Rate for Payer: Prime Health Services Commercial |
$8.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.28
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
OP
|
$3.07
|
|
|
Service Code
|
NDC 0093-3541-43
|
| Hospital Charge Code |
1743763
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: BCBS Transplant Transplant |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.61
|
| Rate for Payer: Dignity Health Media |
$2.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.00
|
| Rate for Payer: Prime Health Services Commercial |
$2.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.61
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
IP
|
$13.04
|
|
|
Service Code
|
NDC 0781-7129-83
|
| Hospital Charge Code |
1743733
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Blue Shield of California Commercial |
$9.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.68
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
OP
|
$13.04
|
|
|
Service Code
|
NDC 0781-7129-83
|
| Hospital Charge Code |
1743733
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.77
|
| Rate for Payer: BCBS Transplant Transplant |
$7.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9.61
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Media |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
IP
|
$13.04
|
|
|
Service Code
|
NDC 0781-7129-58
|
| Hospital Charge Code |
1743733
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Blue Shield of California Commercial |
$9.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.68
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
OP
|
$13.04
|
|
|
Service Code
|
NDC 0781-7129-58
|
| Hospital Charge Code |
1743733
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.77
|
| Rate for Payer: BCBS Transplant Transplant |
$7.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9.61
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Media |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]
|
Facility
OP
|
$72.73
|
|
|
Service Code
|
NDC 50419-491-04
|
| Hospital Charge Code |
ERX37533
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$61.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: BCBS Transplant Transplant |
$43.64
|
| Rate for Payer: Blue Shield of California Commercial |
$53.60
|
| Rate for Payer: Blue Shield of California EPN |
$42.47
|
| Rate for Payer: Cash Price |
$32.73
|
| Rate for Payer: Cigna of CA HMO |
$50.91
|
| Rate for Payer: Cigna of CA PPO |
$50.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.82
|
| Rate for Payer: Dignity Health Media |
$61.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.09
|
| Rate for Payer: Galaxy Health WC |
$61.82
|
| Rate for Payer: Global Benefits Group Commercial |
$43.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$54.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$58.18
|
| Rate for Payer: Networks By Design Commercial |
$47.27
|
| Rate for Payer: Prime Health Services Commercial |
$61.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$43.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.36
|
| Rate for Payer: United Healthcare All Other HMO |
$36.36
|
| Rate for Payer: United Healthcare HMO Rider |
$36.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.82
|
| Rate for Payer: Vantage Medical Group Senior |
$61.82
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]
|
Facility
IP
|
$72.73
|
|
|
Service Code
|
NDC 50419-491-04
|
| Hospital Charge Code |
ERX37533
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$61.82 |
| Rate for Payer: Blue Shield of California Commercial |
$51.78
|
| Rate for Payer: Blue Shield of California EPN |
$37.24
|
| Rate for Payer: Cash Price |
$32.73
|
| Rate for Payer: Cigna of CA HMO |
$50.91
|
| Rate for Payer: Cigna of CA PPO |
$50.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.09
|
| Rate for Payer: Galaxy Health WC |
$61.82
|
| Rate for Payer: Global Benefits Group Commercial |
$43.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$58.18
|
| Rate for Payer: Networks By Design Commercial |
$47.27
|
| Rate for Payer: Prime Health Services Commercial |
$61.82
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
NDC 0781-7144-83
|
| Hospital Charge Code |
1712109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.78
|
| Rate for Payer: BCBS Transplant Transplant |
$7.83
|
| Rate for Payer: Blue Shield of California Commercial |
$9.62
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$9.14
|
| Rate for Payer: Cigna of CA PPO |
$9.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.09
|
| Rate for Payer: Dignity Health Media |
$11.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.09
|
| Rate for Payer: Vantage Medical Group Senior |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
NDC 0781-7144-58
|
| Hospital Charge Code |
1712109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.78
|
| Rate for Payer: BCBS Transplant Transplant |
$7.83
|
| Rate for Payer: Blue Shield of California Commercial |
$9.62
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$9.14
|
| Rate for Payer: Cigna of CA PPO |
$9.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.09
|
| Rate for Payer: Dignity Health Media |
$11.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.09
|
| Rate for Payer: Vantage Medical Group Senior |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
IP
|
$13.05
|
|
|
Service Code
|
NDC 0781-7144-83
|
| Hospital Charge Code |
1712109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Blue Shield of California Commercial |
$9.29
|
| Rate for Payer: Blue Shield of California EPN |
$6.68
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$9.14
|
| Rate for Payer: Cigna of CA PPO |
$9.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
IP
|
$13.05
|
|
|
Service Code
|
NDC 0781-7144-58
|
| Hospital Charge Code |
1712109
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Blue Shield of California Commercial |
$9.29
|
| Rate for Payer: Blue Shield of California EPN |
$6.68
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$9.14
|
| Rate for Payer: Cigna of CA PPO |
$9.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.44
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
OP
|
$22.28
|
|
|
Service Code
|
NDC 0781-7133-58
|
| Hospital Charge Code |
1712268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: BCBS Transplant Transplant |
$13.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$16.42
|
| Rate for Payer: Blue Shield of California EPN |
$13.01
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.94
|
| Rate for Payer: Dignity Health Media |
$18.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Multiplan Commercial |
$17.82
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Vantage Medical Group Senior |
$18.94
|
|
