|
BENZTROPINE 1 MG TABLET [999]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 69315-137-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: InnovAge PACE Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| 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 |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 69315-137-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 0603-2434-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: InnovAge PACE Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| 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 |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]
|
Facility
|
OP
|
$10.48
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.43
|
| Rate for Payer: Blue Shield of California Commercial |
$10.63
|
| Rate for Payer: Blue Shield of California Commercial |
$10.63
|
| Rate for Payer: Blue Shield of California EPN |
$9.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.66
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Central Health Plan Commercial |
$8.38
|
| Rate for Payer: Central Health Plan Commercial |
$10.57
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA HMO |
$7.34
|
| Rate for Payer: Cigna of CA PPO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$7.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.19
|
| Rate for Payer: EPIC Health Plan Senior |
$4.19
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.23
|
| Rate for Payer: Galaxy Health WC |
$8.91
|
| Rate for Payer: Global Benefits Group Commercial |
$7.93
|
| Rate for Payer: Global Benefits Group Commercial |
$6.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.85
|
| Rate for Payer: InnovAge PACE Commercial |
$5.24
|
| Rate for Payer: InnovAge PACE Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$9.91
|
| Rate for Payer: Networks By Design Commercial |
$6.61
|
| Rate for Payer: Networks By Design Commercial |
$5.24
|
| Rate for Payer: Prime Health Services Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.91
|
| Rate for Payer: Riverside University Health System MISP |
$4.19
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$4.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.75
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.23
|
| Rate for Payer: Vantage Medical Group Senior |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$11.23
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]
|
Facility
|
IP
|
$13.21
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.89 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$10.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$10.57
|
| Rate for Payer: Central Health Plan Commercial |
$8.38
|
| Rate for Payer: Cigna of CA HMO |
$7.34
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$7.34
|
| Rate for Payer: Cigna of CA PPO |
$9.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$4.19
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$11.23
|
| Rate for Payer: Global Benefits Group Commercial |
$7.93
|
| Rate for Payer: Global Benefits Group Commercial |
$6.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$9.91
|
| Rate for Payer: Networks By Design Commercial |
$5.24
|
| Rate for Payer: Networks By Design Commercial |
$6.61
|
| Rate for Payer: Prime Health Services Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.75
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.33
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL OINTMENT [9178]
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
NDC 0472-0382-45
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL OINTMENT [9178]
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
NDC 0472-0382-45
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Riverside University Health System MISP |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % LOTION [1028]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 0168-0057-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: InnovAge PACE Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Riverside University Health System MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % LOTION [1028]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 0168-0057-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM [1027]
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 0472-0380-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Central Health Plan Commercial |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$1.81
|
| Rate for Payer: Cigna of CA PPO |
$1.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$2.20
|
| Rate for Payer: Riverside University Health System MISP |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2.20
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM [1027]
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 0472-0380-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Central Health Plan Commercial |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$1.81
|
| Rate for Payer: Cigna of CA PPO |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$2.20
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
|
IP
|
$3.94
|
|
|
Service Code
|
NDC 0168-0056-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.99
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Central Health Plan Commercial |
$3.15
|
| Rate for Payer: Cigna of CA HMO |
$2.76
|
| Rate for Payer: Cigna of CA PPO |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.35
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 0472-0381-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$2.35
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Vantage Medical Group Senior |
$2.67
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
|
OP
|
$3.94
|
|
|
Service Code
|
NDC 0168-0056-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Adventist Health Commercial |
$0.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Central Health Plan Commercial |
$3.15
|
| Rate for Payer: Cigna of CA HMO |
$2.76
|
| Rate for Payer: Cigna of CA PPO |
$2.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.55
|
| Rate for Payer: InnovAge PACE Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.35
|
| Rate for Payer: Riverside University Health System MISP |
$1.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
|
IP
|
$3.14
|
|
|
Service Code
|
NDC 0472-0381-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Adventist Health Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.35
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
NDC 51672-1269-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Senior |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 0713-0326-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Senior |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: InnovAge PACE Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
NDC 0713-0326-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Senior |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
NDC 51672-1269-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Senior |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: InnovAge PACE Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 0168-0033-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: InnovAge PACE Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
|
IP
|
$0.89
|
|
|
Service Code
|
NDC 0168-0033-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.76
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 0472-0371-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 0168-0033-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.80
|
| Rate for Payer: InnovAge PACE Commercial |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.76
|
| Rate for Payer: Riverside University Health System MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Vantage Medical Group Senior |
$0.76
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 0168-0033-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 0472-0371-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: InnovAge PACE Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
