|
HYDROXYZINE PAMOATE 25 MG CAPSULE [3777]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 0555-0323-02
|
| Hospital Charge Code |
1711071
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [3777]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 0555-0323-02
|
| Hospital Charge Code |
1711071
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE [17381]
|
Facility
IP
|
$273.92
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
1721174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$246.53 |
| Rate for Payer: Blue Shield of California Commercial |
$205.44
|
| Rate for Payer: Blue Shield of California EPN |
$146.27
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Central Health Plan Commercial |
$219.14
|
| Rate for Payer: Cigna of CA HMO |
$191.74
|
| Rate for Payer: Cigna of CA PPO |
$191.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$109.57
|
| Rate for Payer: Galaxy Health WC |
$232.83
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.78
|
| Rate for Payer: Multiplan Commercial |
$205.44
|
| Rate for Payer: Networks By Design Commercial |
$136.96
|
| Rate for Payer: Prime Health Services Commercial |
$232.83
|
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE [17381]
|
Facility
OP
|
$273.92
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
1721174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$246.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.74
|
| Rate for Payer: BCBS Transplant Transplant |
$164.35
|
| Rate for Payer: Blue Shield of California Commercial |
$37.66
|
| Rate for Payer: Blue Shield of California EPN |
$34.24
|
| Rate for Payer: Caremore Medicare Advantage |
$9.12
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Central Health Plan Commercial |
$219.14
|
| Rate for Payer: Cigna of CA HMO |
$191.74
|
| Rate for Payer: Cigna of CA PPO |
$191.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.12
|
| Rate for Payer: Galaxy Health WC |
$232.83
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$205.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.96
|
| Rate for Payer: IEHP medi-cal |
$15.05
|
| Rate for Payer: IEHP Medicare Advantage |
$9.12
|
| Rate for Payer: Innovage PACE Commercial |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.22
|
| Rate for Payer: Multiplan Commercial |
$205.44
|
| Rate for Payer: Networks By Design Commercial |
$136.96
|
| Rate for Payer: Prime Health Services Commercial |
$232.83
|
| Rate for Payer: Prime Health Services Medicare |
$9.67
|
| Rate for Payer: Riverside University Health MISP |
$10.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.96
|
| Rate for Payer: United Healthcare All Other HMO |
$136.96
|
| Rate for Payer: United Healthcare HMO Rider |
$136.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Vantage Medical Group Senior |
$9.12
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 39328-048-16
|
| Hospital Charge Code |
NDG3781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| 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 |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 54838-511-80
|
| Hospital Charge Code |
NDG3781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| 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 |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 39328-048-16
|
| Hospital Charge Code |
NDG3781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
| 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 |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| 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 |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.17
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: Riverside University Health MISP |
$0.09
|
| 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 |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 54838-511-80
|
| Hospital Charge Code |
NDG3781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| 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 |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| 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 |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| 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 |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
HYOSCYAMINE 0.125 MG/ML ORAL DROPS [3782]
|
Facility
OP
|
$2.65
|
|
|
Service Code
|
NDC 39328-047-15
|
| Hospital Charge Code |
1719158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.57
|
| Rate for Payer: BCBS Transplant Transplant |
$1.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.30
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Central Health Plan Commercial |
$2.12
|
| Rate for Payer: Cigna of CA HMO |
$1.86
|
| Rate for Payer: Cigna of CA PPO |
$1.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.06
|
| Rate for Payer: Galaxy Health WC |
$2.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.99
|
| Rate for Payer: IEHP medi-cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.99
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$2.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.59
|
| Rate for Payer: Riverside University Health MISP |
$1.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HYOSCYAMINE 0.125 MG/ML ORAL DROPS [3782]
|
Facility
IP
|
$2.65
|
|
|
Service Code
|
NDC 39328-047-15
|
| Hospital Charge Code |
1719158
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Central Health Plan Commercial |
$2.12
|
| Rate for Payer: Cigna of CA HMO |
$1.86
|
| Rate for Payer: Cigna of CA PPO |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: Galaxy Health WC |
$2.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.99
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$2.25
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
NDC 42192-339-01
|
| Hospital Charge Code |
1711556
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: BCBS Transplant Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.41
|
| Rate for Payer: IEHP medi-cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
IP
|
$0.82
|
|
|
Service Code
|
NDC 43199-011-01
|
| Hospital Charge Code |
1711556
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
NDC 42192-339-01
|
| Hospital Charge Code |
1711556
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
OP
|
$0.82
|
|
|
Service Code
|
NDC 43199-011-01
|
| Hospital Charge Code |
1711556
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.62
|
| Rate for Payer: IEHP medi-cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: Riverside University Health MISP |
$0.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
HYOSCYAMINE 0.5 MG/ML INJECTION SOLUTION [10239]
|
Facility
OP
|
$80.30
|
|
|
Service Code
|
CPT J1980
|
| Hospital Charge Code |
1720837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$219.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$219.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$68.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$44.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.73
|
| Rate for Payer: BCBS Transplant Transplant |
$48.18
|
| Rate for Payer: Blue Shield of California Commercial |
$39.16
|
| Rate for Payer: Blue Shield of California EPN |
$35.60
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Central Health Plan Commercial |
$64.24
|
| Rate for Payer: Cigna of CA HMO |
$56.21
|
| Rate for Payer: Cigna of CA PPO |
$56.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.12
|
| Rate for Payer: Galaxy Health WC |
$68.26
|
| Rate for Payer: Global Benefits Group Commercial |
$48.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$60.22
|
| Rate for Payer: IEHP medi-cal |
$28.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.06
|
| Rate for Payer: Multiplan Commercial |
$60.22
|
| Rate for Payer: Networks By Design Commercial |
$40.15
|
| Rate for Payer: Prime Health Services Commercial |
$68.26
|
| Rate for Payer: Riverside University Health MISP |
$32.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.15
|
| Rate for Payer: United Healthcare All Other HMO |
$40.15
|
| Rate for Payer: United Healthcare HMO Rider |
$40.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.26
|
| Rate for Payer: Vantage Medical Group Senior |
$68.26
|
|
|
HYOSCYAMINE 0.5 MG/ML INJECTION SOLUTION [10239]
|
Facility
IP
|
$80.30
|
|
|
Service Code
|
CPT J1980
|
| Hospital Charge Code |
1720837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$72.27 |
| Rate for Payer: Blue Shield of California Commercial |
$60.22
|
| Rate for Payer: Blue Shield of California EPN |
$42.88
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Central Health Plan Commercial |
$64.24
|
| Rate for Payer: Cigna of CA HMO |
$56.21
|
| Rate for Payer: Cigna of CA PPO |
$56.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.12
|
| Rate for Payer: Galaxy Health WC |
$68.26
|
| Rate for Payer: Global Benefits Group Commercial |
$48.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.06
|
| Rate for Payer: Multiplan Commercial |
$60.22
|
| Rate for Payer: Networks By Design Commercial |
$40.15
|
| Rate for Payer: Prime Health Services Commercial |
$68.26
|
|
|
HYPERTENSION
|
Facility
IP
|
$5,959.71
|
|
|
Service Code
|
APR-DRG 1991
|
| Min. Negotiated Rate |
$5,001.16 |
| Max. Negotiated Rate |
$5,959.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,001.16
|
| Rate for Payer: IEHP medi-cal |
$5,959.71
|
|
|
HYPERTENSION
|
Facility
IP
|
$14,647.68
|
|
|
Service Code
|
APR-DRG 1994
|
| Min. Negotiated Rate |
$12,291.76 |
| Max. Negotiated Rate |
$14,647.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,291.76
|
| Rate for Payer: IEHP medi-cal |
$14,647.68
|
|
|
HYPERTENSION
|
Facility
IP
|
$7,282.46
|
|
|
Service Code
|
APR-DRG 1992
|
| Min. Negotiated Rate |
$6,111.16 |
| Max. Negotiated Rate |
$7,282.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,111.16
|
| Rate for Payer: IEHP medi-cal |
$7,282.46
|
|
|
HYPERTENSION
|
Facility
IP
|
$10,030.74
|
|
|
Service Code
|
APR-DRG 1993
|
| Min. Negotiated Rate |
$8,417.40 |
| Max. Negotiated Rate |
$10,030.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,417.40
|
| Rate for Payer: IEHP medi-cal |
$10,030.74
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
IP
|
$8,639.92
|
|
|
Service Code
|
APR-DRG 4223
|
| Min. Negotiated Rate |
$7,250.28 |
| Max. Negotiated Rate |
$8,639.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,250.28
|
| Rate for Payer: IEHP medi-cal |
$8,639.92
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
IP
|
$3,986.94
|
|
|
Service Code
|
APR-DRG 4221
|
| Min. Negotiated Rate |
$3,345.68 |
| Max. Negotiated Rate |
$3,986.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,345.68
|
| Rate for Payer: IEHP medi-cal |
$3,986.94
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
IP
|
$5,935.69
|
|
|
Service Code
|
APR-DRG 4222
|
| Min. Negotiated Rate |
$4,981.00 |
| Max. Negotiated Rate |
$5,935.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,981.00
|
| Rate for Payer: IEHP medi-cal |
$5,935.69
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
IP
|
$15,102.83
|
|
|
Service Code
|
APR-DRG 4224
|
| Min. Negotiated Rate |
$12,673.70 |
| Max. Negotiated Rate |
$15,102.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,673.70
|
| Rate for Payer: IEHP medi-cal |
$15,102.83
|
|
|
HYPROMELLOSE 2.5 % EYE DROPS [38092]
|
Facility
OP
|
$1.55
|
|
|
Service Code
|
NDC 17478-064-12
|
| Hospital Charge Code |
1740135
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.92
|
| Rate for Payer: BCBS Transplant Transplant |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.24
|
| Rate for Payer: Cigna of CA HMO |
$1.08
|
| Rate for Payer: Cigna of CA PPO |
$1.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.16
|
| Rate for Payer: IEHP medi-cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.16
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.93
|
| Rate for Payer: Riverside University Health MISP |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.32
|
|
