|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
|
OP
|
$14.17
|
|
|
Service Code
|
NDC 42494-341-12
|
| Hospital Charge Code |
1748041
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.44
|
| Rate for Payer: Blue Distinction Transplant |
$8.50
|
| Rate for Payer: Blue Shield of California Commercial |
$10.44
|
| Rate for Payer: Blue Shield of California EPN |
$8.28
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$9.92
|
| Rate for Payer: Cigna of CA PPO |
$9.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.04
|
| Rate for Payer: Dignity Health Media |
$12.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.08
|
| Rate for Payer: United Healthcare HMO Rider |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.04
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
OP
|
$19.33
|
|
|
Service Code
|
NDC 50383-901-10
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.52
|
| Rate for Payer: Blue Distinction Transplant |
$11.60
|
| Rate for Payer: Blue Shield of California Commercial |
$14.25
|
| Rate for Payer: Blue Shield of California EPN |
$11.29
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna of CA HMO |
$13.53
|
| Rate for Payer: Cigna of CA PPO |
$13.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.43
|
| Rate for Payer: Dignity Health Media |
$16.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.73
|
| Rate for Payer: Galaxy Health WC |
$16.43
|
| Rate for Payer: Global Benefits Group Commercial |
$11.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$15.46
|
| Rate for Payer: Networks By Design Commercial |
$12.56
|
| Rate for Payer: Prime Health Services Commercial |
$16.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO |
$9.66
|
| Rate for Payer: United Healthcare HMO Rider |
$9.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.43
|
| Rate for Payer: Vantage Medical Group Senior |
$16.43
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
NDC 51672-3007-1
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Blue Shield of California Commercial |
$11.58
|
| Rate for Payer: Blue Shield of California EPN |
$8.33
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cigna of CA HMO |
$11.38
|
| Rate for Payer: Cigna of CA PPO |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
IP
|
$19.33
|
|
|
Service Code
|
NDC 50383-901-10
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$16.43 |
| Rate for Payer: Blue Shield of California Commercial |
$13.76
|
| Rate for Payer: Blue Shield of California EPN |
$9.90
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna of CA HMO |
$13.53
|
| Rate for Payer: Cigna of CA PPO |
$13.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.73
|
| Rate for Payer: Galaxy Health WC |
$16.43
|
| Rate for Payer: Global Benefits Group Commercial |
$11.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$15.46
|
| Rate for Payer: Networks By Design Commercial |
$12.56
|
| Rate for Payer: Prime Health Services Commercial |
$16.43
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
NDC 51672-3007-1
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.69
|
| Rate for Payer: Blue Distinction Transplant |
$9.76
|
| Rate for Payer: Blue Shield of California Commercial |
$11.98
|
| Rate for Payer: Blue Shield of California EPN |
$9.50
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cigna of CA HMO |
$11.38
|
| Rate for Payer: Cigna of CA PPO |
$11.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.82
|
| Rate for Payer: Dignity Health Media |
$13.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.50
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.13
|
| Rate for Payer: United Healthcare All Other HMO |
$8.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.82
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0179-8016-30
|
| Hospital Charge Code |
NDG110413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0179-8016-30
|
| Hospital Charge Code |
NDG110413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Media |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
HYDROCORTISONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0802-81
|
| Hospital Charge Code |
1715652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Distinction Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Media |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
HYDROCORTISONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0802-81
|
| Hospital Charge Code |
1715652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
IP
|
$17.26
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
ERX111163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$14.67 |
| Rate for Payer: Blue Shield of California Commercial |
$12.29
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$12.08
|
| Rate for Payer: Cigna of CA PPO |
$12.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.90
|
| Rate for Payer: Galaxy Health WC |
$14.67
|
| Rate for Payer: Global Benefits Group Commercial |
$10.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$13.81
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$14.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.37
|
| Rate for Payer: United Healthcare HMO Rider |
$6.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
OP
|
$17.26
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
ERX111163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$112.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: Blue Distinction Transplant |
$10.36
|
| Rate for Payer: Blue Shield of California Commercial |
$12.72
|
| Rate for Payer: Blue Shield of California EPN |
$13.04
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cigna of CA HMO |
$12.08
|
| Rate for Payer: Cigna of CA PPO |
$12.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.67
|
| Rate for Payer: Dignity Health Media |
$14.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.90
|
| Rate for Payer: Galaxy Health WC |
$14.67
|
| Rate for Payer: Global Benefits Group Commercial |
$10.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$13.81
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$14.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8.63
|
| Rate for Payer: United Healthcare HMO Rider |
$8.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.67
|
| Rate for Payer: Vantage Medical Group Senior |
$14.67
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
IP
|
$43.14
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
1720335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: Blue Shield of California Commercial |
$30.72
|
| Rate for Payer: Blue Shield of California EPN |
$22.09
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cigna of CA HMO |
$30.20
|
| Rate for Payer: Cigna of CA PPO |
$30.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.26
|
| Rate for Payer: Galaxy Health WC |
$36.67
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$34.51
|
| Rate for Payer: Networks By Design Commercial |
$21.57
|
| Rate for Payer: Prime Health Services Commercial |
$36.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.29
|
| Rate for Payer: United Healthcare All Other HMO |
$15.91
|
| Rate for Payer: United Healthcare HMO Rider |
$15.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.24
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
OP
|
$43.14
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
1720335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$112.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: Blue Distinction Transplant |
$25.88
|
| Rate for Payer: Blue Shield of California Commercial |
$31.79
|
| Rate for Payer: Blue Shield of California EPN |
$13.04
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cigna of CA HMO |
$30.20
|
| Rate for Payer: Cigna of CA PPO |
$30.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.67
|
| Rate for Payer: Dignity Health Media |
$36.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.26
|
| Rate for Payer: Galaxy Health WC |
$36.67
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$34.51
|
| Rate for Payer: Networks By Design Commercial |
$21.57
|
| Rate for Payer: Prime Health Services Commercial |
$36.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.57
|
| Rate for Payer: United Healthcare All Other HMO |
$21.57
|
| Rate for Payer: United Healthcare HMO Rider |
$21.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.67
|
| Rate for Payer: Vantage Medical Group Senior |
$36.67
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
IP
|
$86.32
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
ERX121169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$73.37 |
| Rate for Payer: Blue Shield of California Commercial |
$61.46
|
| Rate for Payer: Blue Shield of California EPN |
$44.20
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna of CA HMO |
$60.42
|
| Rate for Payer: Cigna of CA PPO |
$60.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.53
|
| Rate for Payer: Galaxy Health WC |
$73.37
|
| Rate for Payer: Global Benefits Group Commercial |
$51.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.72
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Networks By Design Commercial |
$43.16
|
| Rate for Payer: Prime Health Services Commercial |
$73.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.59
|
| Rate for Payer: United Healthcare All Other HMO |
$31.83
|
| Rate for Payer: United Healthcare HMO Rider |
$31.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.49
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
OP
|
$86.32
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
ERX121169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$112.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: Blue Distinction Transplant |
$51.79
|
| Rate for Payer: Blue Shield of California Commercial |
$63.62
|
| Rate for Payer: Blue Shield of California EPN |
$13.04
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna of CA HMO |
$60.42
|
| Rate for Payer: Cigna of CA PPO |
$60.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.37
|
| Rate for Payer: Dignity Health Media |
$73.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.53
|
| Rate for Payer: Galaxy Health WC |
$73.37
|
| Rate for Payer: Global Benefits Group Commercial |
$51.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.72
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Networks By Design Commercial |
$43.16
|
| Rate for Payer: Prime Health Services Commercial |
$73.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.16
|
| Rate for Payer: United Healthcare All Other HMO |
$43.16
|
| Rate for Payer: United Healthcare HMO Rider |
$43.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.37
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL CREAM [10218]
|
Facility
|
IP
|
$1.93
|
|
|
Service Code
|
NDC 45802-455-42
|
| Hospital Charge Code |
1743278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL CREAM [10218]
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
NDC 45802-455-42
|
| Hospital Charge Code |
1743278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.15
|
| Rate for Payer: Blue Distinction Transplant |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.64
|
| Rate for Payer: Dignity Health Media |
$1.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO |
$0.97
|
| Rate for Payer: United Healthcare HMO Rider |
$0.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1.64
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 51672-1292-1
|
| Hospital Charge Code |
NDG10219
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.75
|
| Rate for Payer: Blue Distinction Transplant |
$3.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.68
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Media |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 51672-1292-1
|
| Hospital Charge Code |
NDG10219
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION. [4082191]
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
NDG202191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Blue Shield of California Commercial |
$7.09
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.76
|
| Rate for Payer: United Healthcare All Other HMO |
$3.67
|
| Rate for Payer: United Healthcare HMO Rider |
$3.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.29
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION. [4082191]
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
NDG202191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.18
|
| Rate for Payer: Blue Distinction Transplant |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.77
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Media |
$8.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.98
|
| Rate for Payer: United Healthcare All Other HMO |
$4.98
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE [202191]
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
NDG202191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.18
|
| Rate for Payer: Blue Distinction Transplant |
$4.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.10
|
| Rate for Payer: Blue Shield of California EPN |
$3.77
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cigna of CA HMO |
$5.80
|
| Rate for Payer: Cigna of CA PPO |
$5.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.04
|
| Rate for Payer: Dignity Health Media |
$7.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$6.62
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.04
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE [202191]
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
NDG202191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Blue Shield of California Commercial |
$5.90
|
| Rate for Payer: Blue Shield of California EPN |
$4.24
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cigna of CA HMO |
$5.80
|
| Rate for Payer: Cigna of CA PPO |
$5.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$6.62
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.13
|
| Rate for Payer: United Healthcare All Other HMO |
$3.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.73
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SOLUTION [216053]
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
1734065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.18
|
| Rate for Payer: Blue Distinction Transplant |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.77
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$2.28
|
| Rate for Payer: Cigna of CA PPO |
$2.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.76
|
| Rate for Payer: Dignity Health Media |
$2.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.76
|
| Rate for Payer: Vantage Medical Group Senior |
$2.76
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SOLUTION [216053]
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
1734065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$2.28
|
| Rate for Payer: Cigna of CA PPO |
$2.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
|
