|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
OP
|
$4.52
|
|
|
Service Code
|
NDC 0093-6815-73
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.69
|
| Rate for Payer: BCBS Transplant Transplant |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$3.16
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.84
|
| Rate for Payer: Dignity Health Media |
$3.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$3.84
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.62
|
| Rate for Payer: Networks By Design Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.84
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
IP
|
$4.52
|
|
|
Service Code
|
NDC 0093-6815-73
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$3.16
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$3.84
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.62
|
| Rate for Payer: Networks By Design Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.84
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
IP
|
$20.40
|
|
|
Service Code
|
NDC 0487-9601-01
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Blue Shield of California Commercial |
$14.52
|
| Rate for Payer: Blue Shield of California EPN |
$10.44
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cigna of CA HMO |
$14.28
|
| Rate for Payer: Cigna of CA PPO |
$14.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$13.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
OP
|
$4.52
|
|
|
Service Code
|
NDC 0093-6815-45
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.69
|
| Rate for Payer: BCBS Transplant Transplant |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$3.16
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.84
|
| Rate for Payer: Dignity Health Media |
$3.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$3.84
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.62
|
| Rate for Payer: Networks By Design Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.84
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [28774]
|
Facility
IP
|
$4.52
|
|
|
Service Code
|
NDC 0093-6815-45
|
| Hospital Charge Code |
1744095
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$3.16
|
| Rate for Payer: Cigna of CA PPO |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: Galaxy Health WC |
$3.84
|
| Rate for Payer: Global Benefits Group Commercial |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.62
|
| Rate for Payer: Networks By Design Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.84
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 68180-984-30
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$5.60
|
|
|
Service Code
|
NDC 60687-524-79
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.48
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$5.60
|
|
|
Service Code
|
NDC 60687-524-83
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.48
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 68180-984-05
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Media |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$5.58
|
|
|
Service Code
|
NDC 0487-9701-01
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$2.86
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$3.91
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 68180-984-30
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 68180-984-05
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
OP
|
$5.60
|
|
|
Service Code
|
NDC 60687-524-79
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: BCBS Transplant Transplant |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.27
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Media |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.48
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
OP
|
$5.58
|
|
|
Service Code
|
NDC 0487-9701-01
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: BCBS Transplant Transplant |
$3.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$3.91
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.74
|
| Rate for Payer: Dignity Health Media |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.23
|
| Rate for Payer: Galaxy Health WC |
$4.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
| Rate for Payer: Networks By Design Commercial |
$3.63
|
| Rate for Payer: Prime Health Services Commercial |
$4.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [28775]
|
Facility
OP
|
$5.60
|
|
|
Service Code
|
NDC 60687-524-83
|
| Hospital Charge Code |
1744094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: BCBS Transplant Transplant |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.27
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Media |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.48
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$16.20
|
|
|
Service Code
|
NDC 60687-596-33
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.65
|
| Rate for Payer: BCBS Transplant Transplant |
$9.72
|
| Rate for Payer: Blue Shield of California Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California EPN |
$9.46
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.77
|
| Rate for Payer: Dignity Health Media |
$13.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.96
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO |
$8.10
|
| Rate for Payer: United Healthcare HMO Rider |
$8.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.77
|
| Rate for Payer: Vantage Medical Group Senior |
$13.77
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$21.89
|
|
|
Service Code
|
NDC 51079-020-01
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Blue Shield of California Commercial |
$15.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.21
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$17.51
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$21.89
|
|
|
Service Code
|
NDC 51079-020-01
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.04
|
| Rate for Payer: BCBS Transplant Transplant |
$13.13
|
| Rate for Payer: Blue Shield of California Commercial |
$16.13
|
| Rate for Payer: Blue Shield of California EPN |
$12.78
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$15.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Media |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$17.51
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.94
|
| Rate for Payer: United Healthcare All Other HMO |
$10.94
|
| Rate for Payer: United Healthcare HMO Rider |
$10.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$21.89
|
|
|
Service Code
|
NDC 51079-020-03
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Blue Shield of California Commercial |
$15.59
|
| Rate for Payer: Blue Shield of California EPN |
$11.21
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$17.51
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$16.20
|
|
|
Service Code
|
NDC 60687-596-32
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.65
|
| Rate for Payer: BCBS Transplant Transplant |
$9.72
|
| Rate for Payer: Blue Shield of California Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California EPN |
$9.46
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.77
|
| Rate for Payer: Dignity Health Media |
$13.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.48
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.96
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO |
$8.10
|
| Rate for Payer: United Healthcare HMO Rider |
$8.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.77
|
| Rate for Payer: Vantage Medical Group Senior |
$13.77
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$1.19
|
|
|
Service Code
|
NDC 0574-9855-10
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$16.20
|
|
|
Service Code
|
NDC 60687-596-33
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California EPN |
$8.29
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.96
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$21.89
|
|
|
Service Code
|
NDC 51079-020-03
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.04
|
| Rate for Payer: BCBS Transplant Transplant |
$13.13
|
| Rate for Payer: Blue Shield of California Commercial |
$16.13
|
| Rate for Payer: Blue Shield of California EPN |
$12.78
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$15.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Media |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$17.51
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.94
|
| Rate for Payer: United Healthcare All Other HMO |
$10.94
|
| Rate for Payer: United Healthcare HMO Rider |
$10.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
IP
|
$16.20
|
|
|
Service Code
|
NDC 60687-596-32
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California EPN |
$8.29
|
| Rate for Payer: Cash Price |
$7.29
|
| Rate for Payer: Cigna of CA HMO |
$11.34
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$13.77
|
| Rate for Payer: Global Benefits Group Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$12.96
|
| Rate for Payer: Networks By Design Commercial |
$10.53
|
| Rate for Payer: Prime Health Services Commercial |
$13.77
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE [31576]
|
Facility
OP
|
$1.19
|
|
|
Service Code
|
NDC 0574-9855-10
|
| Hospital Charge Code |
1711870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: BCBS Transplant Transplant |
$0.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.01
|
| Rate for Payer: Dignity Health Media |
$1.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1.01
|
|
