|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [1262]
|
Facility
|
IP
|
$16.57
|
|
|
Service Code
|
NDC 0517-2502-10
|
| Hospital Charge Code |
1720528
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Blue Shield of California Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California EPN |
$8.48
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$13.26
|
| Rate for Payer: Networks By Design Commercial |
$10.77
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [1262]
|
Facility
|
OP
|
$16.57
|
|
|
Service Code
|
NDC 0517-2502-01
|
| Hospital Charge Code |
1720528
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.87
|
| Rate for Payer: Blue Distinction Transplant |
$9.94
|
| Rate for Payer: Blue Shield of California Commercial |
$12.21
|
| Rate for Payer: Blue Shield of California EPN |
$9.68
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Media |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$13.26
|
| Rate for Payer: Networks By Design Commercial |
$10.77
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [1262]
|
Facility
|
IP
|
$16.57
|
|
|
Service Code
|
NDC 0517-2502-01
|
| Hospital Charge Code |
1720528
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Blue Shield of California Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California EPN |
$8.48
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$13.26
|
| Rate for Payer: Networks By Design Commercial |
$10.77
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [1262]
|
Facility
|
OP
|
$16.57
|
|
|
Service Code
|
NDC 0517-2502-10
|
| Hospital Charge Code |
1720528
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.87
|
| Rate for Payer: Blue Distinction Transplant |
$9.94
|
| Rate for Payer: Blue Shield of California Commercial |
$12.21
|
| Rate for Payer: Blue Shield of California EPN |
$9.68
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Media |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$13.26
|
| Rate for Payer: Networks By Design Commercial |
$10.77
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION [78879]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0395-0413-96
|
| Hospital Charge Code |
NDG78879B
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION [78879]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0395-0413-96
|
| Hospital Charge Code |
NDG78879B
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION [78879]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0904-2533-21
|
| Hospital Charge Code |
NDG78879B
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION [78879]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0904-2533-21
|
| Hospital Charge Code |
NDG78879B
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM [16034]
|
Facility
|
IP
|
$7.07
|
|
|
Service Code
|
NDC 0781-7117-35
|
| Hospital Charge Code |
1743767
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Blue Shield of California Commercial |
$5.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.62
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$4.95
|
| Rate for Payer: Cigna of CA PPO |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.83
|
| Rate for Payer: Galaxy Health WC |
$6.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$5.66
|
| Rate for Payer: Networks By Design Commercial |
$4.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.01
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM [16034]
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 68462-501-65
|
| Hospital Charge Code |
1743767
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.63
|
| Rate for Payer: Blue Distinction Transplant |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Media |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3.75
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM [16034]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 68462-501-65
|
| Hospital Charge Code |
1743767
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM [16034]
|
Facility
|
OP
|
$7.07
|
|
|
Service Code
|
NDC 0781-7117-35
|
| Hospital Charge Code |
1743767
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.21
|
| Rate for Payer: Blue Distinction Transplant |
$4.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5.21
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$4.95
|
| Rate for Payer: Cigna of CA PPO |
$4.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.01
|
| Rate for Payer: Dignity Health Media |
$6.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.83
|
| Rate for Payer: Galaxy Health WC |
$6.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$5.66
|
| Rate for Payer: Networks By Design Commercial |
$4.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.54
|
| Rate for Payer: United Healthcare All Other HMO |
$3.54
|
| Rate for Payer: United Healthcare HMO Rider |
$3.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.01
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL OINTMENT [12244]
|
Facility
|
OP
|
$6.03
|
|
|
Service Code
|
NDC 66993-878-61
|
| Hospital Charge Code |
NDG12244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.59
|
| Rate for Payer: Blue Distinction Transplant |
$3.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4.44
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$3.86
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: Dignity Health Media |
$5.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL OINTMENT [12244]
|
Facility
|
IP
|
$6.03
|
|
|
Service Code
|
NDC 66993-878-61
|
| Hospital Charge Code |
NDG12244
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL OINTMENT [70383]
|
Facility
|
OP
|
$19.82
|
|
|
Service Code
|
NDC 50222-227-81
|
| Hospital Charge Code |
NDG70383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.81
|
| Rate for Payer: Blue Distinction Transplant |
$11.89
|
| Rate for Payer: Blue Shield of California Commercial |
$14.61
|
| Rate for Payer: Blue Shield of California EPN |
$11.57
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cigna of CA HMO |
$13.87
|
| Rate for Payer: Cigna of CA PPO |
$13.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.85
|
| Rate for Payer: Dignity Health Media |
$16.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.93
|
| Rate for Payer: Galaxy Health WC |
$16.85
|
| Rate for Payer: Global Benefits Group Commercial |
$11.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$15.86
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$16.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.91
|
| Rate for Payer: United Healthcare All Other HMO |
$9.91
|
| Rate for Payer: United Healthcare HMO Rider |
$9.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL OINTMENT [70383]
|
Facility
|
OP
|
$23.78
|
|
|
Service Code
|
NDC 50222-227-04
|
| Hospital Charge Code |
1743778
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$20.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.17
|
| Rate for Payer: Blue Distinction Transplant |
$14.27
|
| Rate for Payer: Blue Shield of California Commercial |
$17.53
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cigna of CA HMO |
$16.65
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.21
|
| Rate for Payer: Dignity Health Media |
$20.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.51
|
| Rate for Payer: Galaxy Health WC |
$20.21
|
| Rate for Payer: Global Benefits Group Commercial |
$14.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$19.02
|
| Rate for Payer: Networks By Design Commercial |
$15.46
|
| Rate for Payer: Prime Health Services Commercial |
$20.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.89
|
| Rate for Payer: United Healthcare All Other HMO |
$11.89
|
| Rate for Payer: United Healthcare HMO Rider |
$11.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$20.21
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL OINTMENT [70383]
|
Facility
|
IP
|
$23.78
|
|
|
Service Code
|
NDC 50222-227-04
|
| Hospital Charge Code |
1743778
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$20.21 |
| Rate for Payer: Blue Shield of California Commercial |
$16.93
|
| Rate for Payer: Blue Shield of California EPN |
$12.18
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cigna of CA HMO |
$16.65
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.51
|
| Rate for Payer: Galaxy Health WC |
$20.21
|
| Rate for Payer: Global Benefits Group Commercial |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$19.02
|
| Rate for Payer: Networks By Design Commercial |
$15.46
|
| Rate for Payer: Prime Health Services Commercial |
$20.21
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL OINTMENT [70383]
|
Facility
|
IP
|
$19.82
|
|
|
Service Code
|
NDC 50222-227-81
|
| Hospital Charge Code |
NDG70383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Blue Shield of California Commercial |
$14.11
|
| Rate for Payer: Blue Shield of California EPN |
$10.15
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cigna of CA HMO |
$13.87
|
| Rate for Payer: Cigna of CA PPO |
$13.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.93
|
| Rate for Payer: Galaxy Health WC |
$16.85
|
| Rate for Payer: Global Benefits Group Commercial |
$11.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$15.86
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$16.85
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL SUSPENSION [91914]
|
Facility
|
IP
|
$25.28
|
|
|
Service Code
|
NDC 50222-501-06
|
| Hospital Charge Code |
NDG91914
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$21.49 |
| Rate for Payer: Blue Shield of California Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California EPN |
$12.94
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cigna of CA HMO |
$17.70
|
| Rate for Payer: Cigna of CA PPO |
$17.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.11
|
| Rate for Payer: Galaxy Health WC |
$21.49
|
| Rate for Payer: Global Benefits Group Commercial |
$15.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$20.22
|
| Rate for Payer: Networks By Design Commercial |
$16.43
|
| Rate for Payer: Prime Health Services Commercial |
$21.49
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL SUSPENSION [91914]
|
Facility
|
OP
|
$25.28
|
|
|
Service Code
|
NDC 50222-501-06
|
| Hospital Charge Code |
NDG91914
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$21.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.06
|
| Rate for Payer: Blue Distinction Transplant |
$15.17
|
| Rate for Payer: Blue Shield of California Commercial |
$18.63
|
| Rate for Payer: Blue Shield of California EPN |
$14.76
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cigna of CA HMO |
$17.70
|
| Rate for Payer: Cigna of CA PPO |
$17.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.49
|
| Rate for Payer: Dignity Health Media |
$21.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.11
|
| Rate for Payer: Galaxy Health WC |
$21.49
|
| Rate for Payer: Global Benefits Group Commercial |
$15.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$20.22
|
| Rate for Payer: Networks By Design Commercial |
$16.43
|
| Rate for Payer: Prime Health Services Commercial |
$21.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.64
|
| Rate for Payer: United Healthcare All Other HMO |
$12.64
|
| Rate for Payer: United Healthcare HMO Rider |
$12.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.49
|
| Rate for Payer: Vantage Medical Group Senior |
$21.49
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]
|
Facility
|
OP
|
$24.28
|
|
|
Service Code
|
NDC 60505-0823-6
|
| Hospital Charge Code |
1744077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$20.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.47
|
| Rate for Payer: Blue Distinction Transplant |
$14.57
|
| Rate for Payer: Blue Shield of California Commercial |
$17.89
|
| Rate for Payer: Blue Shield of California EPN |
$14.18
|
| Rate for Payer: Cash Price |
$10.93
|
| Rate for Payer: Cigna of CA HMO |
$17.00
|
| Rate for Payer: Cigna of CA PPO |
$17.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.64
|
| Rate for Payer: Dignity Health Media |
$20.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.64
|
| Rate for Payer: Global Benefits Group Commercial |
$14.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.83
|
| Rate for Payer: Multiplan Commercial |
$19.42
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.64
|
| Rate for Payer: Vantage Medical Group Senior |
$20.64
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]
|
Facility
|
IP
|
$24.28
|
|
|
Service Code
|
NDC 60505-0823-6
|
| Hospital Charge Code |
1744077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$20.64 |
| Rate for Payer: Blue Shield of California Commercial |
$17.29
|
| Rate for Payer: Blue Shield of California EPN |
$12.43
|
| Rate for Payer: Cash Price |
$10.93
|
| Rate for Payer: Cigna of CA HMO |
$17.00
|
| Rate for Payer: Cigna of CA PPO |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.64
|
| Rate for Payer: Global Benefits Group Commercial |
$14.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.83
|
| Rate for Payer: Multiplan Commercial |
$19.42
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.64
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]
|
Facility
|
IP
|
$1,878.60
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
1720101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$450.86 |
| Max. Negotiated Rate |
$1,596.81 |
| Rate for Payer: Blue Shield of California Commercial |
$1,337.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,338.03
|
| Rate for Payer: Blue Shield of California EPN |
$961.84
|
| Rate for Payer: Blue Shield of California EPN |
$962.18
|
| Rate for Payer: Cash Price |
$845.37
|
| Rate for Payer: Cash Price |
$845.67
|
| Rate for Payer: Cigna of CA HMO |
$1,315.02
|
| Rate for Payer: Cigna of CA HMO |
$1,315.48
|
| Rate for Payer: Cigna of CA PPO |
$1,315.48
|
| Rate for Payer: Cigna of CA PPO |
$1,315.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$751.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$751.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$751.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$751.70
|
| Rate for Payer: Galaxy Health WC |
$1,596.81
|
| Rate for Payer: Galaxy Health WC |
$1,597.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$716.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.02
|
| Rate for Payer: Multiplan Commercial |
$1,502.88
|
| Rate for Payer: Multiplan Commercial |
$1,503.41
|
| Rate for Payer: Networks By Design Commercial |
$939.30
|
| Rate for Payer: Networks By Design Commercial |
$939.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,596.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,597.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.61
|
| Rate for Payer: United Healthcare All Other HMO |
$692.83
|
| Rate for Payer: United Healthcare All Other HMO |
$693.07
|
| Rate for Payer: United Healthcare HMO Rider |
$677.80
|
| Rate for Payer: United Healthcare HMO Rider |
$678.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$619.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.16
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]
|
Facility
|
OP
|
$1,878.60
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
1720101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.01 |
| Max. Negotiated Rate |
$6,726.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,726.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,726.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,336.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,336.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,176.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,176.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.01
|
| Rate for Payer: Blue Distinction Transplant |
$1,127.56
|
| Rate for Payer: Blue Distinction Transplant |
$1,127.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,385.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,384.53
|
| Rate for Payer: Blue Shield of California EPN |
$3,454.52
|
| Rate for Payer: Blue Shield of California EPN |
$3,454.52
|
| Rate for Payer: Cash Price |
$845.67
|
| Rate for Payer: Cash Price |
$845.37
|
| Rate for Payer: Cash Price |
$845.67
|
| Rate for Payer: Cash Price |
$845.37
|
| Rate for Payer: Cigna of CA HMO |
$1,315.48
|
| Rate for Payer: Cigna of CA HMO |
$1,315.02
|
| Rate for Payer: Cigna of CA PPO |
$1,315.02
|
| Rate for Payer: Cigna of CA PPO |
$1,315.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,604.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,604.25
|
| Rate for Payer: Dignity Health Media |
$1,069.50
|
| Rate for Payer: Dignity Health Media |
$1,069.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,176.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,176.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,443.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,443.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,069.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,069.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,069.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,069.50
|
| Rate for Payer: Galaxy Health WC |
$1,596.81
|
| Rate for Payer: Galaxy Health WC |
$1,597.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,408.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,409.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,753.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,753.98
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,753.98
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,753.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,732.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,732.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,732.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,732.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,069.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,069.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,069.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,069.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,347.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,347.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,433.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,433.13
|
| Rate for Payer: Multiplan Commercial |
$1,502.88
|
| Rate for Payer: Multiplan Commercial |
$1,503.41
|
| Rate for Payer: Networks By Design Commercial |
$939.63
|
| Rate for Payer: Networks By Design Commercial |
$939.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,596.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,597.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,127.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,127.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,127.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,127.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.30
|
| Rate for Payer: United Healthcare All Other HMO |
$939.30
|
| Rate for Payer: United Healthcare All Other HMO |
$939.63
|
| Rate for Payer: United Healthcare HMO Rider |
$939.30
|
| Rate for Payer: United Healthcare HMO Rider |
$939.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$939.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$939.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,604.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,604.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,069.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,069.50
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 60687-345-11
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Blue Distinction Transplant |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Media |
$0.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Vantage Medical Group Senior |
$0.76
|
|
