|
BENZTROPINE 1 MG TABLET [999]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 0603-2434-21
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Distinction Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Media |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| 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 |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 69315-137-01
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Distinction Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Media |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| 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 |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 69315-137-01
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| 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 |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 0603-2434-21
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| 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 |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 0603-2438-21
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| 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 |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
BENZTROPINE 2 MG TABLET [1000]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 76385-105-01
|
| Hospital Charge Code |
1710775
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Distinction 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) 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: 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
|
|
|
BENZTROPINE 2 MG TABLET [1000]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 76385-105-01
|
| Hospital Charge Code |
1710775
|
|
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
|
|
|
BENZTROPINE 2 MG TABLET [1000]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0603-2439-21
|
| Hospital Charge Code |
1710775
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Media |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
BENZTROPINE 2 MG TABLET [1000]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 0603-2439-21
|
| Hospital Charge Code |
1710775
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]
|
Facility
|
IP
|
$13.21
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
1720213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Blue Shield of California Commercial |
$9.41
|
| Rate for Payer: Blue Shield of California Commercial |
$6.39
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California EPN |
$4.60
|
| Rate for Payer: Blue Shield of California EPN |
$5.11
|
| Rate for Payer: Blue Shield of California EPN |
$6.76
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cigna of CA HMO |
$6.99
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.59
|
| Rate for Payer: Galaxy Health WC |
$7.63
|
| Rate for Payer: Galaxy Health WC |
$11.23
|
| Rate for Payer: Galaxy Health WC |
$8.48
|
| Rate for Payer: Global Benefits Group Commercial |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.93
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$10.57
|
| Rate for Payer: Multiplan Commercial |
$7.18
|
| Rate for Payer: Multiplan Commercial |
$7.98
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$4.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$7.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$3.68
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.77
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.29
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]
|
Facility
|
OP
|
$13.21
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
1720213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.39
|
| Rate for Payer: Blue Distinction Transplant |
$5.99
|
| Rate for Payer: Blue Distinction Transplant |
$5.39
|
| Rate for Payer: Blue Distinction Transplant |
$7.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6.62
|
| Rate for Payer: Blue Shield of California Commercial |
$9.74
|
| Rate for Payer: Blue Shield of California Commercial |
$7.36
|
| Rate for Payer: Blue Shield of California EPN |
$8.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.98
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cigna of CA HMO |
$6.99
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$6.99
|
| Rate for Payer: Cigna of CA PPO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.48
|
| Rate for Payer: Dignity Health Media |
$7.63
|
| Rate for Payer: Dignity Health Media |
$11.23
|
| Rate for Payer: Dignity Health Media |
$8.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.59
|
| Rate for Payer: Galaxy Health WC |
$8.48
|
| Rate for Payer: Galaxy Health WC |
$11.23
|
| Rate for Payer: Galaxy Health WC |
$7.63
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.93
|
| Rate for Payer: Global Benefits Group Commercial |
$5.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.18
|
| Rate for Payer: Multiplan Commercial |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$10.57
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$4.99
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$7.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.99
|
| Rate for Payer: United Healthcare All Other HMO |
$4.99
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4.49
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.49
|
| Rate for Payer: United Healthcare HMO Rider |
$4.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.48
|
| Rate for Payer: Vantage Medical Group Senior |
$8.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7.63
|
| Rate for Payer: Vantage Medical Group Senior |
$11.23
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM [9175]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 68462-290-17
|
| Hospital Charge Code |
1743496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM [9175]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 68462-290-17
|
| Hospital Charge Code |
1743496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Distinction Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL OINTMENT [9178]
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
NDC 0472-0382-45
|
| Hospital Charge Code |
1743379
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL OINTMENT [9178]
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
NDC 0472-0382-45
|
| Hospital Charge Code |
1743379
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.69
|
| Rate for Payer: Blue Distinction Transplant |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: Dignity Health Media |
$2.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % LOTION [1028]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 0168-0057-60
|
| Hospital Charge Code |
1743383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % LOTION [1028]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 0168-0057-60
|
| Hospital Charge Code |
1743383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: Blue Distinction Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Media |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM [1027]
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 0472-0380-15
|
| Hospital Charge Code |
1743546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.81
|
| Rate for Payer: Cigna of CA PPO |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.07
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$2.20
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM [1027]
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 0472-0380-15
|
| Hospital Charge Code |
1743546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: Blue Distinction Transplant |
$1.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.51
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.81
|
| Rate for Payer: Cigna of CA PPO |
$1.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.20
|
| Rate for Payer: Dignity Health Media |
$2.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.07
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$2.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2.20
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
|
OP
|
$3.94
|
|
|
Service Code
|
NDC 0168-0056-15
|
| Hospital Charge Code |
1743377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Blue Distinction Transplant |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.30
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cigna of CA HMO |
$2.76
|
| Rate for Payer: Cigna of CA PPO |
$2.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.35
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 0472-0381-15
|
| Hospital Charge Code |
1743377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.87
|
| Rate for Payer: Blue Distinction Transplant |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: Dignity Health Media |
$2.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Vantage Medical Group Senior |
$2.67
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
|
IP
|
$3.14
|
|
|
Service Code
|
NDC 0472-0381-15
|
| Hospital Charge Code |
1743377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
|
IP
|
$3.94
|
|
|
Service Code
|
NDC 0168-0056-15
|
| Hospital Charge Code |
1743377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cigna of CA HMO |
$2.76
|
| Rate for Payer: Cigna of CA PPO |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.35
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 51672-1269-1
|
| Hospital Charge Code |
1743469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.85
|
| Rate for Payer: Blue Distinction Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Media |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.07
|
| 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 |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
NDC 51672-1269-1
|
| Hospital Charge Code |
1743469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| 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 |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
