|
HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 45802-004-03
|
| Hospital Charge Code |
1743657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 51672-3003-2
|
| Hospital Charge Code |
1743657
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
OP
|
$2.77
|
|
|
Service Code
|
NDC 62559-431-30
|
| Hospital Charge Code |
1748044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.64
|
| Rate for Payer: BCBS Transplant Transplant |
$1.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.35
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.08
|
| Rate for Payer: IEHP medi-cal |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: Riverside University Health MISP |
$1.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
OP
|
$6.58
|
|
|
Service Code
|
NDC 65649-401-30
|
| Hospital Charge Code |
1748044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.89
|
| Rate for Payer: BCBS Transplant Transplant |
$3.95
|
| Rate for Payer: Blue Shield of California Commercial |
$4.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Central Health Plan Commercial |
$5.26
|
| Rate for Payer: Cigna of CA HMO |
$4.61
|
| Rate for Payer: Cigna of CA PPO |
$4.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.63
|
| Rate for Payer: Galaxy Health WC |
$5.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.94
|
| Rate for Payer: IEHP medi-cal |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$4.28
|
| Rate for Payer: Prime Health Services Commercial |
$5.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.95
|
| Rate for Payer: Riverside University Health MISP |
$2.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.29
|
| Rate for Payer: United Healthcare All Other HMO |
$3.29
|
| Rate for Payer: United Healthcare HMO Rider |
$3.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.59
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
IP
|
$6.58
|
|
|
Service Code
|
NDC 65649-401-30
|
| Hospital Charge Code |
1748044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Blue Shield of California Commercial |
$4.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Central Health Plan Commercial |
$5.26
|
| Rate for Payer: Cigna of CA HMO |
$4.61
|
| Rate for Payer: Cigna of CA PPO |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.63
|
| Rate for Payer: Galaxy Health WC |
$5.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$4.28
|
| Rate for Payer: Prime Health Services Commercial |
$5.59
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
OP
|
$0.80
|
|
|
Service Code
|
NDC 64980-324-30
|
| Hospital Charge Code |
1748044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| 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: BCBS Transplant Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.36
|
| 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: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.60
|
| Rate for Payer: IEHP medi-cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
IP
|
$0.80
|
|
|
Service Code
|
NDC 64980-324-30
|
| Hospital Charge Code |
1748044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| 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: 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: 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
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
IP
|
$2.77
|
|
|
Service Code
|
NDC 62559-431-30
|
| Hospital Charge Code |
1748044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Central Health Plan Commercial |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
|
|
HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 0168-0146-30
|
| Hospital Charge Code |
1743576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 0168-0146-30
|
| Hospital Charge Code |
1743576
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 45802-014-02
|
| Hospital Charge Code |
NDG3732
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 45802-014-02
|
| Hospital Charge Code |
NDG3732
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
HYDROCORTISONE 5 MG TABLET [10209]
|
Facility
OP
|
$0.21
|
|
|
Service Code
|
NDC 59762-0073-1
|
| Hospital Charge Code |
1710846
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.16
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
HYDROCORTISONE 5 MG TABLET [10209]
|
Facility
IP
|
$0.21
|
|
|
Service Code
|
NDC 59762-0073-1
|
| Hospital Charge Code |
1710846
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
|
HYDROCORTISONE 5 MG TABLET [10209]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 0115-1696-06
|
| Hospital Charge Code |
1710846
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.26
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
HYDROCORTISONE 5 MG TABLET [10209]
|
Facility
IP
|
$0.34
|
|
|
Service Code
|
NDC 0115-1696-06
|
| Hospital Charge Code |
1710846
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.29
|
|
|
HYDROCORTISONE ACETATE 0.5 % TOPICAL CREAM [3736]
|
Facility
OP
|
$0.07
|
|
|
Service Code
|
NDC 8770155397
|
| Hospital Charge Code |
NDG3736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| 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: BCBS Transplant Transplant |
$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: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
HYDROCORTISONE ACETATE 0.5 % TOPICAL CREAM [3736]
|
Facility
OP
|
$0.07
|
|
|
Service Code
|
NDC 24385-190-03
|
| Hospital Charge Code |
NDG3736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| 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: BCBS Transplant Transplant |
$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: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
HYDROCORTISONE ACETATE 0.5 % TOPICAL CREAM [3736]
|
Facility
IP
|
$0.07
|
|
|
Service Code
|
NDC 8770155397
|
| Hospital Charge Code |
NDG3736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.05
|
| 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 ACETATE 0.5 % TOPICAL CREAM [3736]
|
Facility
IP
|
$0.07
|
|
|
Service Code
|
NDC 24385-190-03
|
| Hospital Charge Code |
NDG3736
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.05
|
| 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 ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
IP
|
$14.17
|
|
|
Service Code
|
NDC 42494-341-12
|
| Hospital Charge Code |
1748041
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Blue Shield of California Commercial |
$10.63
|
| Rate for Payer: Blue Shield of California EPN |
$7.57
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Central Health Plan Commercial |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$9.92
|
| Rate for Payer: Cigna of CA PPO |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$10.63
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
OP
|
$14.17
|
|
|
Service Code
|
NDC 42494-341-12
|
| Hospital Charge Code |
1748041
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.37
|
| Rate for Payer: BCBS Transplant Transplant |
$8.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8.91
|
| Rate for Payer: Blue Shield of California EPN |
$6.93
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Central Health Plan Commercial |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$9.92
|
| Rate for Payer: Cigna of CA PPO |
$9.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.63
|
| Rate for Payer: IEHP medi-cal |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$10.63
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.50
|
| Rate for Payer: Riverside University Health MISP |
$5.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.08
|
| Rate for Payer: United Healthcare HMO Rider |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.04
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
IP
|
$19.33
|
|
|
Service Code
|
NDC 50383-901-10
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Blue Shield of California Commercial |
$14.50
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Central Health Plan Commercial |
$15.46
|
| Rate for Payer: Cigna of CA HMO |
$13.53
|
| Rate for Payer: Cigna of CA PPO |
$13.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.73
|
| Rate for Payer: Galaxy Health WC |
$16.43
|
| Rate for Payer: Global Benefits Group Commercial |
$11.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.50
|
| Rate for Payer: Networks By Design Commercial |
$12.56
|
| Rate for Payer: Prime Health Services Commercial |
$16.43
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
OP
|
$16.26
|
|
|
Service Code
|
NDC 51672-3007-1
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$14.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.61
|
| Rate for Payer: BCBS Transplant Transplant |
$9.76
|
| Rate for Payer: Blue Shield of California Commercial |
$10.23
|
| Rate for Payer: Blue Shield of California EPN |
$7.95
|
| 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: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$12.20
|
| Rate for Payer: IEHP medi-cal |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.85
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.76
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$13.82
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
IP
|
$16.26
|
|
|
Service Code
|
NDC 51672-3007-1
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$14.63 |
| Rate for Payer: Blue Shield of California Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California EPN |
$8.68
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$10.85
|
| 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
|
|
