|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
IP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-3
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Blue Shield of California Commercial |
$133.20
|
| Rate for Payer: Blue Shield of California EPN |
$94.84
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
IP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-5
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Blue Shield of California Commercial |
$133.20
|
| Rate for Payer: Blue Shield of California EPN |
$94.84
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-1
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$150.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.93
|
| Rate for Payer: BCBS Transplant Transplant |
$106.56
|
| Rate for Payer: Blue Shield of California Commercial |
$111.71
|
| Rate for Payer: Blue Shield of California EPN |
$86.85
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: Cigna of CA HMO |
$113.66
|
| Rate for Payer: Cigna of CA PPO |
$131.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$133.20
|
| Rate for Payer: IEHP medi-cal |
$62.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: Riverside University Health MISP |
$71.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.80
|
| Rate for Payer: United Healthcare All Other HMO |
$88.80
|
| Rate for Payer: United Healthcare HMO Rider |
$88.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.96
|
| Rate for Payer: Vantage Medical Group Senior |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-3
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$150.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.93
|
| Rate for Payer: BCBS Transplant Transplant |
$106.56
|
| Rate for Payer: Blue Shield of California Commercial |
$111.71
|
| Rate for Payer: Blue Shield of California EPN |
$86.85
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: Cigna of CA HMO |
$113.66
|
| Rate for Payer: Cigna of CA PPO |
$131.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$133.20
|
| Rate for Payer: IEHP medi-cal |
$62.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: Riverside University Health MISP |
$71.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.80
|
| Rate for Payer: United Healthcare All Other HMO |
$88.80
|
| Rate for Payer: United Healthcare HMO Rider |
$88.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.96
|
| Rate for Payer: Vantage Medical Group Senior |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-5
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$150.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.93
|
| Rate for Payer: BCBS Transplant Transplant |
$106.56
|
| Rate for Payer: Blue Shield of California Commercial |
$111.71
|
| Rate for Payer: Blue Shield of California EPN |
$86.85
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: Cigna of CA HMO |
$113.66
|
| Rate for Payer: Cigna of CA PPO |
$131.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$133.20
|
| Rate for Payer: IEHP medi-cal |
$62.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
| Rate for Payer: Riverside University Health MISP |
$71.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.80
|
| Rate for Payer: United Healthcare All Other HMO |
$88.80
|
| Rate for Payer: United Healthcare HMO Rider |
$88.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.96
|
| Rate for Payer: Vantage Medical Group Senior |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-58
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$232.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$325.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$210.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$210.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.15
|
| Rate for Payer: BCBS Transplant Transplant |
$229.67
|
| Rate for Payer: Blue Shield of California Commercial |
$240.77
|
| Rate for Payer: Blue Shield of California EPN |
$187.18
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$287.09
|
| Rate for Payer: IEHP medi-cal |
$133.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
| Rate for Payer: Riverside University Health MISP |
$153.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Vantage Medical Group Senior |
$325.37
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
IP
|
$177.60
|
|
|
Service Code
|
NDC 81298-5010-1
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$159.84 |
| Rate for Payer: Blue Shield of California Commercial |
$133.20
|
| Rate for Payer: Blue Shield of California EPN |
$94.84
|
| Rate for Payer: Cash Price |
$79.92
|
| Rate for Payer: Central Health Plan Commercial |
$142.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.04
|
| Rate for Payer: Galaxy Health WC |
$150.96
|
| Rate for Payer: Global Benefits Group Commercial |
$106.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$133.20
|
| Rate for Payer: Networks By Design Commercial |
$115.44
|
| Rate for Payer: Prime Health Services Commercial |
$150.96
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
IP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-11
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Blue Shield of California Commercial |
$287.09
|
| Rate for Payer: Blue Shield of California EPN |
$204.41
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION [9413]
|
Facility
OP
|
$382.79
|
|
|
Service Code
|
NDC 43598-698-11
|
| Hospital Charge Code |
1720386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$232.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$325.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$210.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$210.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.15
|
| Rate for Payer: BCBS Transplant Transplant |
$229.67
|
| Rate for Payer: Blue Shield of California Commercial |
$240.77
|
| Rate for Payer: Blue Shield of California EPN |
$187.18
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.23
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.37
|
| Rate for Payer: Global Benefits Group Commercial |
$229.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$287.09
|
| Rate for Payer: IEHP medi-cal |
$133.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.09
|
| Rate for Payer: Networks By Design Commercial |
$248.81
|
| Rate for Payer: Prime Health Services Commercial |
$325.37
|
| Rate for Payer: Riverside University Health MISP |
$153.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.37
|
| Rate for Payer: Vantage Medical Group Senior |
$325.37
|
|
|
CARBOXYMETHYL 0.5 %-GLYCERIN 1 %-POLYSORB 80 0.5 %-PF EYE DROPPERETTE [201979]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 0023-4491-30
|
| Hospital Charge Code |
ERX201979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
CARBOXYMETHYL 0.5 %-GLYCERIN 1 %-POLYSORB 80 0.5 %-PF EYE DROPPERETTE [201979]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 0023-4491-30
|
| Hospital Charge Code |
ERX201979
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Riverside University Health MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
IP
|
$0.61
|
|
|
Service Code
|
NDC 50268-068-15
|
| Hospital Charge Code |
1740385
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
IP
|
$0.67
|
|
|
Service Code
|
NDC 0023-0798-15
|
| Hospital Charge Code |
1740385
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
OP
|
$0.67
|
|
|
Service Code
|
NDC 0023-0798-15
|
| Hospital Charge Code |
1740385
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: IEHP medi-cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: Riverside University Health MISP |
$0.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS [111282]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
NDC 50268-068-15
|
| Hospital Charge Code |
1740385
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]
|
Facility
OP
|
$0.33
|
|
|
Service Code
|
NDC 0023-0403-50
|
| Hospital Charge Code |
ERX27991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| 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 Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| 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: 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 Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| 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: Riverside University Health MISP |
$0.13
|
| 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 Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 0023-0403-30
|
| Hospital Charge Code |
ERX27991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 0023-0403-30
|
| Hospital Charge Code |
ERX27991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: BCBS Transplant Transplant |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.27
|
| Rate for Payer: IEHP medi-cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]
|
Facility
IP
|
$0.33
|
|
|
Service Code
|
NDC 0023-0403-50
|
| Hospital Charge Code |
ERX27991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| 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: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE [38321]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
NDC 0023-4554-30
|
| Hospital Charge Code |
1740288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE [38321]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 0023-4554-30
|
| Hospital Charge Code |
1740288
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
| Rate for Payer: IEHP medi-cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: Riverside University Health MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS [27992]
|
Facility
IP
|
$0.69
|
|
|
Service Code
|
NDC 0023-9205-15
|
| Hospital Charge Code |
1740305
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS [27992]
|
Facility
OP
|
$0.69
|
|
|
Service Code
|
NDC 0023-9205-15
|
| Hospital Charge Code |
1740305
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: BCBS Transplant Transplant |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.28
|
| Rate for Payer: Galaxy Health WC |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.52
|
| Rate for Payer: IEHP medi-cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: Riverside University Health MISP |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
IP
|
$4,402.04
|
|
|
Service Code
|
APR-DRG 1961
|
| Min. Negotiated Rate |
$3,694.02 |
| Max. Negotiated Rate |
$4,402.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,694.02
|
| Rate for Payer: IEHP medi-cal |
$4,402.04
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
IP
|
$10,142.86
|
|
|
Service Code
|
APR-DRG 1963
|
| Min. Negotiated Rate |
$8,511.49 |
| Max. Negotiated Rate |
$10,142.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,511.49
|
| Rate for Payer: IEHP medi-cal |
$10,142.86
|
|
