|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
IP
|
$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: Blue Shield of California Commercial |
$15.86
|
| Rate for Payer: Blue Shield of California EPN |
$11.41
|
| 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: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| 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
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
OP
|
$22.28
|
|
|
Service Code
|
NDC 0781-7133-54
|
| Hospital Charge Code |
1712268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$18.94 |
| 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: BCBS Transplant Transplant |
$13.37
|
| 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
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
IP
|
$22.28
|
|
|
Service Code
|
NDC 0781-7133-54
|
| Hospital Charge Code |
1712268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Blue Shield of California Commercial |
$15.86
|
| Rate for Payer: Blue Shield of California EPN |
$11.41
|
| 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: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| 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
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
IP
|
$19.57
|
|
|
Service Code
|
NDC 65162-228-08
|
| Hospital Charge Code |
1712110
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Blue Shield of California Commercial |
$13.93
|
| Rate for Payer: Blue Shield of California EPN |
$10.02
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$15.66
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
OP
|
$19.57
|
|
|
Service Code
|
NDC 65162-228-08
|
| Hospital Charge Code |
1712110
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: BCBS Transplant Transplant |
$11.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.66
|
| Rate for Payer: Blue Shield of California Commercial |
$14.42
|
| Rate for Payer: Blue Shield of California EPN |
$11.43
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.63
|
| Rate for Payer: Dignity Health Media |
$16.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$15.66
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.78
|
| Rate for Payer: United Healthcare All Other HMO |
$9.78
|
| Rate for Payer: United Healthcare HMO Rider |
$9.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
OP
|
$19.57
|
|
|
Service Code
|
NDC 65162-228-04
|
| Hospital Charge Code |
1712110
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.66
|
| Rate for Payer: BCBS Transplant Transplant |
$11.74
|
| Rate for Payer: Blue Shield of California Commercial |
$14.42
|
| Rate for Payer: Blue Shield of California EPN |
$11.43
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.63
|
| Rate for Payer: Dignity Health Media |
$16.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$15.66
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.78
|
| Rate for Payer: United Healthcare All Other HMO |
$9.78
|
| Rate for Payer: United Healthcare HMO Rider |
$9.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
IP
|
$19.57
|
|
|
Service Code
|
NDC 65162-228-04
|
| Hospital Charge Code |
1712110
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Blue Shield of California Commercial |
$13.93
|
| Rate for Payer: Blue Shield of California EPN |
$10.02
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$15.66
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
IP
|
$22.28
|
|
|
Service Code
|
NDC 0378-3352-99
|
| Hospital Charge Code |
1712226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Blue Shield of California Commercial |
$15.86
|
| Rate for Payer: Blue Shield of California EPN |
$11.41
|
| 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: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| 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
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
OP
|
$22.28
|
|
|
Service Code
|
NDC 0378-3352-16
|
| Hospital Charge Code |
1712226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$18.94 |
| 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: BCBS Transplant Transplant |
$13.37
|
| 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
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
IP
|
$22.28
|
|
|
Service Code
|
NDC 0378-3352-16
|
| Hospital Charge Code |
1712226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Blue Shield of California Commercial |
$15.86
|
| Rate for Payer: Blue Shield of California EPN |
$11.41
|
| 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: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| 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
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
OP
|
$22.28
|
|
|
Service Code
|
NDC 0378-3352-99
|
| Hospital Charge Code |
1712226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Galaxy Health WC |
$18.94
|
| 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: BCBS Transplant Transplant |
$13.37
|
| 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: 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
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 42806-087-01
|
| Hospital Charge Code |
1712562
|
|
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
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
OP
|
$6.54
|
|
|
Service Code
|
NDC 0430-0720-24
|
| Hospital Charge Code |
1712562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$5.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.90
|
| Rate for Payer: BCBS Transplant Transplant |
$3.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4.82
|
| Rate for Payer: Blue Shield of California EPN |
$3.82
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$4.58
|
| Rate for Payer: Cigna of CA PPO |
$4.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.56
|
| Rate for Payer: Dignity Health Media |
$5.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.62
|
| Rate for Payer: Galaxy Health WC |
$5.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.25
|
| Rate for Payer: Prime Health Services Commercial |
$5.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.27
|
| Rate for Payer: United Healthcare All Other HMO |
$3.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
IP
|
$6.54
|
|
|
Service Code
|
NDC 0430-0720-24
|
| Hospital Charge Code |
1712562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$5.56 |
| Rate for Payer: Blue Shield of California Commercial |
$4.66
|
| Rate for Payer: Blue Shield of California EPN |
$3.35
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$4.58
|
| Rate for Payer: Cigna of CA PPO |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: Galaxy Health WC |
$5.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.25
|
| Rate for Payer: Prime Health Services Commercial |
$5.56
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 42806-087-01
|
| Hospital Charge Code |
1712562
|
|
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
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
IP
|
$0.32
|
|
|
Service Code
|
NDC 51862-332-01
|
| Hospital Charge Code |
1712562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
OP
|
$0.32
|
|
|
Service Code
|
NDC 51862-332-01
|
| Hospital Charge Code |
1712562
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Media |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
ESTRADIOL 1 MG TABLET [9967]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
NDC 42806-088-01
|
| Hospital Charge Code |
1710537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| 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 |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
ESTRADIOL 1 MG TABLET [9967]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
NDC 42806-088-01
|
| Hospital Charge Code |
1710537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| 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 |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 0555-0887-02
|
| Hospital Charge Code |
1710546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Media |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 42806-089-01
|
| Hospital Charge Code |
1710546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| 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 |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 42806-089-01
|
| Hospital Charge Code |
1710546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| 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 |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| 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 |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 51862-334-01
|
| Hospital Charge Code |
1710546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 51862-334-01
|
| Hospital Charge Code |
1710546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Media |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 0555-0887-02
|
| Hospital Charge Code |
1710546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
