|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 5026841111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 5026841111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 4249434112
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 4249434112
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
NDC 5167230071
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$14.63 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California Commercial |
$13.04
|
| Rate for Payer: Blue Shield of California EPN |
$8.20
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Central Health Plan Commercial |
$13.01
|
| Rate for Payer: Cigna of CA HMO |
$11.38
|
| Rate for Payer: Cigna of CA PPO |
$11.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Senior |
$6.50
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
NDC 5167230071
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$14.63 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.46
|
| Rate for Payer: Blue Shield of California Commercial |
$10.31
|
| Rate for Payer: Blue Shield of California EPN |
$6.49
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Central Health Plan Commercial |
$13.01
|
| Rate for Payer: Cigna of CA HMO |
$11.38
|
| Rate for Payer: Cigna of CA PPO |
$11.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Senior |
$6.50
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.38
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
| Rate for Payer: Riverside University Health System MISP |
$6.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.13
|
| Rate for Payer: United Healthcare All Other HMO |
$8.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.82
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0179801630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0179801630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
HYDROCORTISONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 9994080281
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| 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: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| 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 |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.25
|
| 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 Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
HYDROCORTISONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 9994080281
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$127.56 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.52
|
| Rate for Payer: Blue Shield of California Commercial |
$20.72
|
| Rate for Payer: Blue Shield of California EPN |
$18.84
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$17.74
|
| Rate for Payer: Cigna of CA PPO |
$17.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$10.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.54
|
| Rate for Payer: Vantage Medical Group Senior |
$21.54
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
IP
|
$25.34
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Blue Shield of California Commercial |
$20.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.77
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$17.74
|
| Rate for Payer: Cigna of CA PPO |
$17.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.30
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [121171]
|
Facility
|
OP
|
$31.26
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$127.56 |
| Rate for Payer: Adventist Health Commercial |
$6.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.52
|
| Rate for Payer: Blue Shield of California Commercial |
$20.72
|
| Rate for Payer: Blue Shield of California EPN |
$18.84
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Senior |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.88
|
| Rate for Payer: Multiplan Commercial |
$23.45
|
| Rate for Payer: Networks By Design Commercial |
$15.63
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
| Rate for Payer: Riverside University Health System MISP |
$12.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.42
|
| Rate for Payer: United Healthcare HMO Rider |
$11.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.57
|
| Rate for Payer: Vantage Medical Group Senior |
$26.57
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [121171]
|
Facility
|
IP
|
$31.26
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Adventist Health Commercial |
$6.25
|
| Rate for Payer: Blue Shield of California Commercial |
$25.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.76
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Central Health Plan Commercial |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$21.88
|
| Rate for Payer: Cigna of CA PPO |
$21.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.50
|
| Rate for Payer: EPIC Health Plan Senior |
$12.50
|
| Rate for Payer: Galaxy Health WC |
$26.57
|
| Rate for Payer: Global Benefits Group Commercial |
$18.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$23.45
|
| Rate for Payer: Networks By Design Commercial |
$15.63
|
| Rate for Payer: Prime Health Services Commercial |
$26.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.42
|
| Rate for Payer: United Healthcare HMO Rider |
$11.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.24
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
OP
|
$60.57
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$127.56 |
| Rate for Payer: Adventist Health Commercial |
$12.11
|
| Rate for Payer: Adventist Health Commercial |
$12.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.52
|
| Rate for Payer: Blue Shield of California Commercial |
$20.72
|
| Rate for Payer: Blue Shield of California Commercial |
$20.72
|
| Rate for Payer: Blue Shield of California EPN |
$18.84
|
| Rate for Payer: Blue Shield of California EPN |
$18.84
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cash Price |
$27.26
|
| Rate for Payer: Cash Price |
$27.26
|
| Rate for Payer: Central Health Plan Commercial |
$48.46
|
| Rate for Payer: Central Health Plan Commercial |
$51.62
|
| Rate for Payer: Cigna of CA HMO |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$45.16
|
| Rate for Payer: Cigna of CA PPO |
$45.16
|
| Rate for Payer: Cigna of CA PPO |
$42.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.81
|
| Rate for Payer: EPIC Health Plan Senior |
$24.23
|
| Rate for Payer: EPIC Health Plan Senior |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$54.84
|
| Rate for Payer: Galaxy Health WC |
$51.48
|
| Rate for Payer: Global Benefits Group Commercial |
$36.34
|
| Rate for Payer: Global Benefits Group Commercial |
$38.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.16
|
| Rate for Payer: Multiplan Commercial |
$48.39
|
| Rate for Payer: Multiplan Commercial |
$45.43
|
| Rate for Payer: Networks By Design Commercial |
$32.26
|
| Rate for Payer: Networks By Design Commercial |
$30.29
|
| Rate for Payer: Prime Health Services Commercial |
$51.48
|
| Rate for Payer: Prime Health Services Commercial |
$54.84
|
| Rate for Payer: Riverside University Health System MISP |
$25.81
|
| Rate for Payer: Riverside University Health System MISP |
$24.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.21
|
| Rate for Payer: United Healthcare All Other HMO |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO |
$22.13
|
| Rate for Payer: United Healthcare HMO Rider |
$21.65
|
| Rate for Payer: United Healthcare HMO Rider |
$23.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.84
|
| Rate for Payer: Vantage Medical Group Senior |
$54.84
|
| Rate for Payer: Vantage Medical Group Senior |
$51.48
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
IP
|
$64.52
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$58.07 |
| Rate for Payer: Adventist Health Commercial |
$12.90
|
| Rate for Payer: Adventist Health Commercial |
$12.11
|
| Rate for Payer: Blue Shield of California Commercial |
$51.75
|
| Rate for Payer: Blue Shield of California Commercial |
$48.58
|
| Rate for Payer: Blue Shield of California EPN |
$30.53
|
| Rate for Payer: Blue Shield of California EPN |
$32.52
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cash Price |
$27.26
|
| Rate for Payer: Central Health Plan Commercial |
$51.62
|
| Rate for Payer: Central Health Plan Commercial |
$48.46
|
| Rate for Payer: Cigna of CA HMO |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$45.16
|
| Rate for Payer: Cigna of CA PPO |
$42.40
|
| Rate for Payer: Cigna of CA PPO |
$45.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.81
|
| Rate for Payer: EPIC Health Plan Senior |
$24.23
|
| Rate for Payer: EPIC Health Plan Senior |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$54.84
|
| Rate for Payer: Galaxy Health WC |
$51.48
|
| Rate for Payer: Global Benefits Group Commercial |
$36.34
|
| Rate for Payer: Global Benefits Group Commercial |
$38.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.11
|
| Rate for Payer: Multiplan Commercial |
$45.43
|
| Rate for Payer: Multiplan Commercial |
$48.39
|
| Rate for Payer: Networks By Design Commercial |
$30.29
|
| Rate for Payer: Networks By Design Commercial |
$32.26
|
| Rate for Payer: Prime Health Services Commercial |
$54.84
|
| Rate for Payer: Prime Health Services Commercial |
$51.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.21
|
| Rate for Payer: United Healthcare All Other HMO |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO |
$22.13
|
| Rate for Payer: United Healthcare HMO Rider |
$21.65
|
| Rate for Payer: United Healthcare HMO Rider |
$23.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.13
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
OP
|
$126.71
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$127.56 |
| Rate for Payer: Adventist Health Commercial |
$25.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.52
|
| Rate for Payer: Blue Shield of California Commercial |
$20.72
|
| Rate for Payer: Blue Shield of California EPN |
$18.84
|
| Rate for Payer: Cash Price |
$57.02
|
| Rate for Payer: Cash Price |
$57.02
|
| Rate for Payer: Central Health Plan Commercial |
$101.37
|
| Rate for Payer: Cigna of CA HMO |
$88.70
|
| Rate for Payer: Cigna of CA PPO |
$88.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$107.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.68
|
| Rate for Payer: EPIC Health Plan Senior |
$50.68
|
| Rate for Payer: Galaxy Health WC |
$107.70
|
| Rate for Payer: Global Benefits Group Commercial |
$76.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$88.70
|
| Rate for Payer: Multiplan Commercial |
$95.03
|
| Rate for Payer: Networks By Design Commercial |
$63.35
|
| Rate for Payer: Prime Health Services Commercial |
$107.70
|
| Rate for Payer: Riverside University Health System MISP |
$50.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.55
|
| Rate for Payer: United Healthcare All Other HMO |
$46.29
|
| Rate for Payer: United Healthcare HMO Rider |
$45.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.70
|
| Rate for Payer: Vantage Medical Group Senior |
$107.70
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
IP
|
$126.71
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$114.04 |
| Rate for Payer: Adventist Health Commercial |
$25.34
|
| Rate for Payer: Blue Shield of California Commercial |
$101.62
|
| Rate for Payer: Blue Shield of California EPN |
$63.86
|
| Rate for Payer: Cash Price |
$57.02
|
| Rate for Payer: Central Health Plan Commercial |
$101.37
|
| Rate for Payer: Cigna of CA HMO |
$88.70
|
| Rate for Payer: Cigna of CA PPO |
$88.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.68
|
| Rate for Payer: EPIC Health Plan Senior |
$50.68
|
| Rate for Payer: Galaxy Health WC |
$107.70
|
| Rate for Payer: Global Benefits Group Commercial |
$76.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.34
|
| Rate for Payer: Multiplan Commercial |
$95.03
|
| Rate for Payer: Networks By Design Commercial |
$63.35
|
| Rate for Payer: Prime Health Services Commercial |
$107.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.55
|
| Rate for Payer: United Healthcare All Other HMO |
$46.29
|
| Rate for Payer: United Healthcare HMO Rider |
$45.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.50
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 5167212921
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$4.09
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Riverside University Health System MISP |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 5167212921
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$4.41
|
| Rate for Payer: Cigna of CA PPO |
$4.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$4.09
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION. [4082191]
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.99
|
| Rate for Payer: Blue Shield of California Commercial |
$28.87
|
| Rate for Payer: Blue Shield of California EPN |
$18.14
|
| Rate for Payer: Blue Shield of California EPN |
$5.02
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$7.97
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.74
|
| Rate for Payer: United Healthcare All Other HMO |
$3.64
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION. [4082191]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$7.97
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Riverside University Health System MISP |
$3.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.74
|
| Rate for Payer: United Healthcare All Other HMO |
$3.64
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION. [4081869]
|
Facility
|
IP
|
$4.98
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Central Health Plan Commercial |
$3.98
|
| Rate for Payer: Cigna of CA HMO |
$3.49
|
| Rate for Payer: Cigna of CA PPO |
$3.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1.99
|
| Rate for Payer: Galaxy Health WC |
$4.23
|
| Rate for Payer: Global Benefits Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
| Rate for Payer: Networks By Design Commercial |
$2.49
|
| Rate for Payer: Prime Health Services Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.63
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION. [4081869]
|
Facility
|
OP
|
$4.98
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Central Health Plan Commercial |
$3.98
|
| Rate for Payer: Cigna of CA HMO |
$3.49
|
| Rate for Payer: Cigna of CA PPO |
$3.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1.99
|
| Rate for Payer: Galaxy Health WC |
$4.23
|
| Rate for Payer: Global Benefits Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
| Rate for Payer: Networks By Design Commercial |
$2.49
|
| Rate for Payer: Prime Health Services Commercial |
$4.23
|
| Rate for Payer: Riverside University Health System MISP |
$1.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.23
|
| Rate for Payer: Vantage Medical Group Senior |
$4.23
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 9999910225
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.83
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.83
|
| Rate for Payer: Cigna of CA HMO |
$0.73
|
| Rate for Payer: Cigna of CA PPO |
$0.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
