NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
IP
|
$0.34
|
|
Service Code
|
NDC 0121-0868-50
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.17
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO |
$0.24
|
Rate for Payer: Cigna of CA PPO |
$0.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: Galaxy Health WC |
$0.29
|
Rate for Payer: Global Benefits Group Commercial |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.27
|
Rate for Payer: Networks By Design Commercial |
$0.22
|
Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
OP
|
$0.34
|
|
Service Code
|
NDC 0121-0868-50
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
Rate for Payer: BCBS Transplant Transplant |
$0.20
|
Rate for Payer: Blue Shield of California Commercial |
$0.25
|
Rate for Payer: Blue Shield of California EPN |
$0.20
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO |
$0.24
|
Rate for Payer: Cigna of CA PPO |
$0.24
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
Rate for Payer: Dignity Health Media |
$0.29
|
Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
Rate for Payer: Galaxy Health WC |
$0.29
|
Rate for Payer: Global Benefits Group Commercial |
$0.20
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.27
|
Rate for Payer: Networks By Design Commercial |
$0.22
|
Rate for Payer: Prime Health Services Commercial |
$0.29
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
Rate for Payer: United Healthcare All Other HMO |
$0.17
|
Rate for Payer: United Healthcare HMO Rider |
$0.17
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
OP
|
$0.33
|
|
Service Code
|
NDC 68094-599-59
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.28 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
Rate for Payer: BCBS Transplant Transplant |
$0.20
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.19
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO |
$0.23
|
Rate for Payer: Cigna of CA PPO |
$0.23
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
Rate for Payer: Dignity Health Media |
$0.28
|
Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.28
|
Rate for Payer: Global Benefits Group Commercial |
$0.20
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.28
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
Rate for Payer: United Healthcare All Other HMO |
$0.17
|
Rate for Payer: United Healthcare HMO Rider |
$0.17
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
OP
|
$0.34
|
|
Service Code
|
NDC 68094-599-62
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
Rate for Payer: BCBS Transplant Transplant |
$0.20
|
Rate for Payer: Blue Shield of California Commercial |
$0.25
|
Rate for Payer: Blue Shield of California EPN |
$0.20
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO |
$0.24
|
Rate for Payer: Cigna of CA PPO |
$0.24
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
Rate for Payer: Dignity Health Media |
$0.29
|
Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
Rate for Payer: Galaxy Health WC |
$0.29
|
Rate for Payer: Global Benefits Group Commercial |
$0.20
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.27
|
Rate for Payer: Networks By Design Commercial |
$0.22
|
Rate for Payer: Prime Health Services Commercial |
$0.29
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
Rate for Payer: United Healthcare All Other HMO |
$0.17
|
Rate for Payer: United Healthcare HMO Rider |
$0.17
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
IP
|
$0.33
|
|
Service Code
|
NDC 0121-0868-00
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.28 |
Rate for Payer: Blue Shield of California Commercial |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.17
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO |
$0.23
|
Rate for Payer: Cigna of CA PPO |
$0.23
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.28
|
Rate for Payer: Global Benefits Group Commercial |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
OP
|
$0.20
|
|
Service Code
|
NDC 66689-037-01
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
Rate for Payer: BCBS Transplant Transplant |
$0.12
|
Rate for Payer: Blue Shield of California Commercial |
$0.15
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of CA HMO |
$0.14
|
Rate for Payer: Cigna of CA PPO |
$0.14
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
Rate for Payer: Dignity Health Media |
$0.17
|
Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
Rate for Payer: Galaxy Health WC |
$0.17
|
Rate for Payer: Global Benefits Group Commercial |
$0.12
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.15
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.16
|
Rate for Payer: Networks By Design Commercial |
$0.13
|
Rate for Payer: Prime Health Services Commercial |
$0.17
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.12
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
Rate for Payer: United Healthcare All Other HMO |
$0.10
|
Rate for Payer: United Healthcare HMO Rider |
$0.10
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
IP
|
$0.34
|
|
Service Code
|
NDC 0121-0868-40
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: Networks By Design Commercial |
$0.22
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.17
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO |
$0.24
|
Rate for Payer: Cigna of CA PPO |
$0.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: Galaxy Health WC |
$0.29
|
Rate for Payer: Global Benefits Group Commercial |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.27
|
Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
IP
|
$0.20
|
|
Service Code
|
NDC 66689-037-01
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: Blue Shield of California Commercial |
$0.14
|
Rate for Payer: Blue Shield of California EPN |
$0.10
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of CA HMO |
$0.14
|
Rate for Payer: Cigna of CA PPO |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
Rate for Payer: Galaxy Health WC |
$0.17
|
Rate for Payer: Global Benefits Group Commercial |
$0.12
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.16
|
Rate for Payer: Networks By Design Commercial |
$0.13
|
Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
IP
|
$0.34
|
|
Service Code
|
NDC 68094-599-62
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: Galaxy Health WC |
$0.29
|
Rate for Payer: Blue Shield of California Commercial |
$0.24
|
Rate for Payer: Blue Shield of California EPN |
$0.17
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO |
$0.24
|
Rate for Payer: Cigna of CA PPO |
$0.24
|
Rate for Payer: Global Benefits Group Commercial |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.27
|
Rate for Payer: Networks By Design Commercial |
$0.22
|
Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
IP
|
$0.33
|
|
Service Code
|
NDC 68094-599-59
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.28 |
Rate for Payer: Blue Shield of California Commercial |
$0.23
|
Rate for Payer: Blue Shield of California EPN |
$0.17
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO |
$0.23
|
Rate for Payer: Cigna of CA PPO |
$0.23
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Galaxy Health WC |
$0.28
|
Rate for Payer: Global Benefits Group Commercial |
$0.20
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Networks By Design Commercial |
$0.21
|
Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
OP
|
$0.34
|
|
Service Code
|
NDC 0121-0868-40
|
Hospital Charge Code |
1716066
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
Rate for Payer: BCBS Transplant Transplant |
$0.20
|
Rate for Payer: Blue Shield of California Commercial |
$0.25
|
Rate for Payer: Blue Shield of California EPN |
$0.20
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO |
$0.24
|
Rate for Payer: Cigna of CA PPO |
$0.24
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
Rate for Payer: Dignity Health Media |
$0.29
|
Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
Rate for Payer: Galaxy Health WC |
$0.29
|
Rate for Payer: Global Benefits Group Commercial |
$0.20
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
Rate for Payer: Multiplan Commercial |
$0.27
|
Rate for Payer: Networks By Design Commercial |
$0.22
|
Rate for Payer: Prime Health Services Commercial |
$0.29
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
Rate for Payer: United Healthcare All Other HMO |
$0.17
|
Rate for Payer: United Healthcare HMO Rider |
$0.17
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$1.00
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
Rate for Payer: BCBS Transplant 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 Transplant Other |
$0.89
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.71
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
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
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: AlphaCare Medical Group Commercial/Exchange |
$1.00
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
Rate for Payer: BCBS Transplant 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 Transplant Other |
$0.89
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.71
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
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
|
$1.68
|
|
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
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
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: AlphaCare Medical Group Commercial/Exchange |
$6.09
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.94
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.94
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.27
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$4.30
|
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
IP
|
$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: Blue Shield of California Commercial |
$3.63
|
Rate for Payer: Blue Shield of California EPN |
$2.61
|
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: EPIC Health Plan Commercial |
$2.04
|
Rate for Payer: Galaxy Health WC |
$4.34
|
Rate for Payer: Global Benefits Group Commercial |
$3.06
|
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
|
|
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
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
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: Vantage Medical Group Medi-Cal |
$4.56
|
Rate for Payer: Vantage Medical Group Senior |
$4.56
|
Rate for Payer: Aetna of CA HMO/PPO |
$3.52
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.56
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.95
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.95
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3.22
|
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
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
OP
|
$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: Galaxy Health WC |
$1.43
|
Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
Rate for Payer: BCBS Transplant Transplant |
$1.01
|
Rate for Payer: Blue Shield of California Commercial |
$1.24
|
Rate for Payer: Blue Shield of California EPN |
$0.98
|
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: Dignity Health Commercial/Exchange |
$1.43
|
Rate for Payer: Dignity Health Media |
$1.43
|
Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
Rate for Payer: Global Benefits Group Commercial |
$1.01
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
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
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
Rate for Payer: United Healthcare All Other HMO |
$0.84
|
Rate for Payer: United Healthcare HMO Rider |
$0.84
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$4.34
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.80
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.80
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.04
|
Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3.06
|
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
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
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
|
|
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: BCBS Transplant Transplant |
$0.61
|
Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.86
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.56
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.56
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.61
|
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
|
|