|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 51672-1263-1
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
NDC 51672-1263-2
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Blue Distinction Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.53
|
| 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 |
$1.00
|
| Rate for Payer: Dignity Health Media |
$1.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) 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 |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| 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 |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 51672-1263-2
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.53
|
| 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 |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| 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 |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 68180-545-02
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.53
|
| 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 |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| 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 |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
NDC 0472-0150-30
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.04
|
| Rate for Payer: Blue Distinction Transplant |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.57
|
| Rate for Payer: Cigna of CA PPO |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.34
|
| Rate for Payer: Dignity Health Media |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$4.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.55
|
| Rate for Payer: United Healthcare All Other HMO |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$4.34
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
OP
|
$7.16
|
|
|
Service Code
|
NDC 0472-0150-15
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.27
|
| Rate for Payer: Blue Distinction Transplant |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.18
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$5.01
|
| Rate for Payer: Cigna of CA PPO |
$5.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.09
|
| Rate for Payer: Dignity Health Media |
$6.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$5.73
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Vantage Medical Group Senior |
$6.09
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
OP
|
$5.37
|
|
|
Service Code
|
NDC 0168-0081-15
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Distinction Transplant |
$3.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$3.76
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.56
|
| Rate for Payer: Dignity Health Media |
$4.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.15
|
| Rate for Payer: Galaxy Health WC |
$4.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.49
|
| Rate for Payer: Prime Health Services Commercial |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.56
|
| Rate for Payer: Vantage Medical Group Senior |
$4.56
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
NDC 68180-545-02
|
| Hospital Charge Code |
1743543
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Blue Distinction Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.53
|
| 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 |
$1.00
|
| Rate for Payer: Dignity Health Media |
$1.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) 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 |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| 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 |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
IP
|
$5.37
|
|
|
Service Code
|
NDC 0168-0081-15
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.75
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$3.76
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.15
|
| Rate for Payer: Galaxy Health WC |
$4.56
|
| Rate for Payer: Global Benefits Group Commercial |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.49
|
| Rate for Payer: Prime Health Services Commercial |
$4.56
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
IP
|
$7.16
|
|
|
Service Code
|
NDC 0472-0150-15
|
| Hospital Charge Code |
1743540
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Blue Shield of California Commercial |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$3.67
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$5.01
|
| Rate for Payer: Cigna of CA PPO |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$5.73
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT [5755]
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
NDC 68462-799-17
|
| Hospital Charge Code |
1743557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.86
|
| Rate for Payer: Dignity Health Media |
$0.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Vantage Medical Group Senior |
$0.86
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT [5755]
|
Facility
|
IP
|
$1.01
|
|
|
Service Code
|
NDC 68462-799-17
|
| Hospital Charge Code |
1743557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [204196]
|
Facility
|
IP
|
$233.26
|
|
|
Service Code
|
CPT J9301
|
| Hospital Charge Code |
NDG204196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.98 |
| Max. Negotiated Rate |
$198.27 |
| Rate for Payer: Blue Shield of California Commercial |
$166.08
|
| Rate for Payer: Blue Shield of California EPN |
$119.43
|
| Rate for Payer: Cash Price |
$104.97
|
| Rate for Payer: Cigna of CA HMO |
$163.28
|
| Rate for Payer: Cigna of CA PPO |
$163.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.30
|
| Rate for Payer: Galaxy Health WC |
$198.27
|
| Rate for Payer: Global Benefits Group Commercial |
$139.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.98
|
| Rate for Payer: Multiplan Commercial |
$186.61
|
| Rate for Payer: Networks By Design Commercial |
$116.63
|
| Rate for Payer: Prime Health Services Commercial |
$198.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.08
|
| Rate for Payer: United Healthcare All Other HMO |
$86.03
|
| Rate for Payer: United Healthcare HMO Rider |
$84.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.98
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [204196]
|
Facility
|
OP
|
$233.26
|
|
|
Service Code
|
CPT J9301
|
| Hospital Charge Code |
NDG204196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.98 |
| Max. Negotiated Rate |
$198.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.97
|
| Rate for Payer: Blue Distinction Transplant |
$139.96
|
| Rate for Payer: Blue Shield of California Commercial |
$171.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.79
|
| Rate for Payer: Cash Price |
$104.97
|
| Rate for Payer: Cash Price |
$104.97
|
| Rate for Payer: Cigna of CA HMO |
$163.28
|
| Rate for Payer: Cigna of CA PPO |
$163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.51
|
| Rate for Payer: Dignity Health Media |
$70.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$70.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.34
|
| Rate for Payer: Galaxy Health WC |
$198.27
|
| Rate for Payer: Global Benefits Group Commercial |
$139.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$174.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.36
|
| Rate for Payer: Heritage Provider Network Transplant |
$115.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$113.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.26
|
| Rate for Payer: Multiplan Commercial |
$186.61
|
| Rate for Payer: Networks By Design Commercial |
$116.63
|
| Rate for Payer: Prime Health Services Commercial |
$198.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.63
|
| Rate for Payer: United Healthcare All Other HMO |
$116.63
|
| Rate for Payer: United Healthcare HMO Rider |
$116.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.38
|
| Rate for Payer: Vantage Medical Group Senior |
$70.34
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION [216963]
|
Facility
|
OP
|
$2,253.07
|
|
|
Service Code
|
CPT J2350
|
| Hospital Charge Code |
NDG216963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$1,915.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$375.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: Blue Distinction Transplant |
$1,351.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,660.51
|
| Rate for Payer: Blue Shield of California EPN |
$65.00
|
| Rate for Payer: Cash Price |
$1,013.88
|
| Rate for Payer: Cash Price |
$1,013.88
|
| Rate for Payer: Cigna of CA HMO |
$1,577.15
|
| Rate for Payer: Cigna of CA PPO |
$1,577.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.63
|
| Rate for Payer: Dignity Health Media |
$59.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.75
|
| Rate for Payer: Galaxy Health WC |
$1,915.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,689.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$96.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.07
|
| Rate for Payer: Multiplan Commercial |
$1,802.46
|
| Rate for Payer: Networks By Design Commercial |
$1,126.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,351.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,126.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,126.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,126.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.73
|
| Rate for Payer: Vantage Medical Group Senior |
$59.75
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION [216963]
|
Facility
|
IP
|
$2,253.07
|
|
|
Service Code
|
CPT J2350
|
| Hospital Charge Code |
NDG216963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$540.74 |
| Max. Negotiated Rate |
$1,915.11 |
| Rate for Payer: Blue Shield of California Commercial |
$1,604.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,153.57
|
| Rate for Payer: Cash Price |
$1,013.88
|
| Rate for Payer: Cigna of CA HMO |
$1,577.15
|
| Rate for Payer: Cigna of CA PPO |
$1,577.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$901.23
|
| Rate for Payer: Galaxy Health WC |
$1,915.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.74
|
| Rate for Payer: Multiplan Commercial |
$1,802.46
|
| Rate for Payer: Networks By Design Commercial |
$1,126.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$850.76
|
| Rate for Payer: United Healthcare All Other HMO |
$830.93
|
| Rate for Payer: United Healthcare HMO Rider |
$812.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.51
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
NDG91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$101.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: Blue Distinction Transplant |
$71.55
|
| Rate for Payer: Blue Shield of California Commercial |
$87.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cigna of CA HMO |
$83.48
|
| Rate for Payer: Cigna of CA PPO |
$83.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.36
|
| Rate for Payer: Dignity Health Media |
$101.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.70
|
| Rate for Payer: Galaxy Health WC |
$101.36
|
| Rate for Payer: Global Benefits Group Commercial |
$71.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$89.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.62
|
| Rate for Payer: Multiplan Commercial |
$95.40
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$101.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.62
|
| Rate for Payer: United Healthcare All Other HMO |
$59.62
|
| Rate for Payer: United Healthcare HMO Rider |
$59.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.36
|
| Rate for Payer: Vantage Medical Group Senior |
$101.36
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
NDG91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$101.36 |
| Rate for Payer: Blue Shield of California Commercial |
$84.91
|
| Rate for Payer: Blue Shield of California EPN |
$61.06
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cigna of CA HMO |
$83.48
|
| Rate for Payer: Cigna of CA PPO |
$83.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.70
|
| Rate for Payer: Galaxy Health WC |
$101.36
|
| Rate for Payer: Global Benefits Group Commercial |
$71.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.62
|
| Rate for Payer: Multiplan Commercial |
$95.40
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$101.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.03
|
| Rate for Payer: United Healthcare All Other HMO |
$43.98
|
| Rate for Payer: United Healthcare HMO Rider |
$43.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.35
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]
|
Facility
|
IP
|
$7.80
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Blue Shield of California Commercial |
$5.55
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.88
|
| Rate for Payer: United Healthcare HMO Rider |
$2.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.57
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]
|
Facility
|
OP
|
$7.80
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: Blue Distinction Transplant |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: Dignity Health Media |
$6.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Blue Shield of California Commercial |
$9.18
|
| Rate for Payer: Blue Shield of California Commercial |
$29.90
|
| Rate for Payer: Blue Shield of California Commercial |
$42.46
|
| Rate for Payer: Blue Shield of California EPN |
$21.50
|
| Rate for Payer: Blue Shield of California EPN |
$30.53
|
| Rate for Payer: Blue Shield of California EPN |
$6.60
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cigna of CA HMO |
$41.74
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA HMO |
$9.03
|
| Rate for Payer: Cigna of CA PPO |
$9.03
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$41.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$10.96
|
| Rate for Payer: Galaxy Health WC |
$50.69
|
| Rate for Payer: Global Benefits Group Commercial |
$35.78
|
| Rate for Payer: Global Benefits Group Commercial |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.31
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$47.70
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Networks By Design Commercial |
$29.82
|
| Rate for Payer: Prime Health Services Commercial |
$10.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$50.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$15.49
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$21.99
|
| Rate for Payer: United Healthcare HMO Rider |
$21.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.65
|
| Rate for Payer: United Healthcare HMO Rider |
$15.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.68
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]
|
Facility
|
OP
|
$12.90
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: Blue Distinction Transplant |
$35.78
|
| Rate for Payer: Blue Distinction Transplant |
$25.20
|
| Rate for Payer: Blue Distinction Transplant |
$7.74
|
| Rate for Payer: Blue Shield of California Commercial |
$30.95
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California Commercial |
$43.95
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$41.74
|
| Rate for Payer: Cigna of CA HMO |
$9.03
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$41.74
|
| Rate for Payer: Cigna of CA PPO |
$9.03
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.69
|
| Rate for Payer: Dignity Health Media |
$35.70
|
| Rate for Payer: Dignity Health Media |
$10.96
|
| Rate for Payer: Dignity Health Media |
$50.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$50.69
|
| Rate for Payer: Galaxy Health WC |
$10.96
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$35.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$47.70
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$29.82
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$50.69
|
| Rate for Payer: Prime Health Services Commercial |
$10.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.82
|
| Rate for Payer: United Healthcare All Other HMO |
$29.82
|
| Rate for Payer: United Healthcare All Other HMO |
$6.45
|
| Rate for Payer: United Healthcare All Other HMO |
$21.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.45
|
| Rate for Payer: United Healthcare HMO Rider |
$21.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.69
|
| Rate for Payer: Vantage Medical Group Senior |
$50.69
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10.96
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.78
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: Blue Distinction Transplant |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Media |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
OCTREOTIDE,MICROSPHERES 20 MG INTRAMUSCULAR WRAP, LONG-ACTING RELEASE [40824435]
|
Facility
|
IP
|
$5,324.45
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX24435
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,277.87 |
| Max. Negotiated Rate |
$4,525.78 |
| Rate for Payer: Blue Shield of California Commercial |
$3,791.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,726.12
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,727.12
|
| Rate for Payer: Cigna of CA PPO |
$3,727.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,129.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,129.78
|
| Rate for Payer: Galaxy Health WC |
$4,525.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,028.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.87
|
| Rate for Payer: Multiplan Commercial |
$4,259.56
|
| Rate for Payer: Networks By Design Commercial |
$2,662.22
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,010.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1,963.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,921.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,757.07
|
|
