|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
NDC 51672-3007-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California Commercial |
$12.56
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Central Health Plan Commercial |
$13.00
|
| 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: EPIC Health Plan Senior |
$6.50
|
| Rate for Payer: Galaxy Health WC |
$13.81
|
| Rate for Payer: Global Benefits Group Commercial |
$9.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$12.19
|
| Rate for Payer: Networks By Design Commercial |
$10.56
|
| Rate for Payer: Prime Health Services Commercial |
$13.81
|
|
|
HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0179-8016-30
|
| 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 |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA 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 0179-8016-30
|
| 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 |
$0.04
|
| 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: 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: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA 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
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0802-81
|
| 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 |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.34
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| 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 ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0802-81
|
| 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 |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.34
|
| 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: 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: InnovAge PACE Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA 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 SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
IP
|
$22.98
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Blue Shield of California Commercial |
$17.76
|
| Rate for Payer: Blue Shield of California EPN |
$11.58
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Central Health Plan Commercial |
$18.38
|
| Rate for Payer: Cigna of CA HMO |
$16.09
|
| Rate for Payer: Cigna of CA PPO |
$16.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.19
|
| Rate for Payer: EPIC Health Plan Senior |
$9.19
|
| Rate for Payer: Galaxy Health WC |
$19.53
|
| Rate for Payer: Global Benefits Group Commercial |
$13.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: Networks By Design Commercial |
$11.49
|
| Rate for Payer: Prime Health Services Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.62
|
| Rate for Payer: United Healthcare All Other HMO |
$8.39
|
| Rate for Payer: United Healthcare HMO Rider |
$8.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
OP
|
$22.98
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$48.26 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.60
|
| 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 |
$12.64
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Central Health Plan Commercial |
$18.38
|
| Rate for Payer: Cigna of CA HMO |
$16.09
|
| Rate for Payer: Cigna of CA PPO |
$16.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.19
|
| Rate for Payer: EPIC Health Plan Senior |
$9.19
|
| Rate for Payer: Galaxy Health WC |
$19.53
|
| Rate for Payer: Global Benefits Group Commercial |
$13.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.58
|
| Rate for Payer: InnovAge PACE Commercial |
$11.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.09
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: Networks By Design Commercial |
$11.49
|
| Rate for Payer: Prime Health Services Commercial |
$19.53
|
| Rate for Payer: Riverside University Health System MISP |
$9.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.62
|
| Rate for Payer: United Healthcare All Other HMO |
$8.39
|
| Rate for Payer: United Healthcare HMO Rider |
$8.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.53
|
| Rate for Payer: Vantage Medical Group Senior |
$19.53
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [121171]
|
Facility
|
IP
|
$28.88
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$25.99 |
| Rate for Payer: Adventist Health Commercial |
$5.78
|
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Blue Shield of California Commercial |
$22.32
|
| Rate for Payer: Blue Shield of California Commercial |
$21.91
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Blue Shield of California EPN |
$14.56
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Central Health Plan Commercial |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$22.68
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA HMO |
$20.22
|
| Rate for Payer: Cigna of CA PPO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$20.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.55
|
| Rate for Payer: EPIC Health Plan Senior |
$11.34
|
| Rate for Payer: EPIC Health Plan Senior |
$11.55
|
| Rate for Payer: Galaxy Health WC |
$24.10
|
| Rate for Payer: Galaxy Health WC |
$24.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: Multiplan Commercial |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$21.66
|
| Rate for Payer: Networks By Design Commercial |
$14.18
|
| Rate for Payer: Networks By Design Commercial |
$14.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.55
|
| Rate for Payer: Prime Health Services Commercial |
$24.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10.55
|
| Rate for Payer: United Healthcare All Other HMO |
$10.36
|
| Rate for Payer: United Healthcare HMO Rider |
$10.13
|
| Rate for Payer: United Healthcare HMO Rider |
$10.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.46
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [121171]
|
Facility
|
OP
|
$28.35
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$48.26 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Adventist Health Commercial |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.60
|
| 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 |
$15.59
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Central Health Plan Commercial |
$22.68
|
| Rate for Payer: Central Health Plan Commercial |
$23.10
|
| Rate for Payer: Cigna of CA HMO |
$20.22
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$20.22
|
| Rate for Payer: Cigna of CA PPO |
$19.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.34
|
| Rate for Payer: EPIC Health Plan Senior |
$11.34
|
| Rate for Payer: EPIC Health Plan Senior |
$11.55
|
| Rate for Payer: Galaxy Health WC |
$24.55
|
| Rate for Payer: Galaxy Health WC |
$24.10
|
| Rate for Payer: Global Benefits Group Commercial |
$17.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.58
|
| Rate for Payer: InnovAge PACE Commercial |
$14.18
|
| Rate for Payer: InnovAge PACE Commercial |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.84
|
| Rate for Payer: Multiplan Commercial |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$21.66
|
| Rate for Payer: Networks By Design Commercial |
$14.44
|
| Rate for Payer: Networks By Design Commercial |
$14.18
|
| Rate for Payer: Prime Health Services Commercial |
$24.55
|
| Rate for Payer: Prime Health Services Commercial |
$24.10
|
| Rate for Payer: Riverside University Health System MISP |
$11.34
|
| Rate for Payer: Riverside University Health System MISP |
$11.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.64
|
| Rate for Payer: United Healthcare All Other HMO |
$10.36
|
| Rate for Payer: United Healthcare All Other HMO |
$10.55
|
| Rate for Payer: United Healthcare HMO Rider |
$10.13
|
| Rate for Payer: United Healthcare HMO Rider |
$10.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.55
|
| Rate for Payer: Vantage Medical Group Senior |
$24.10
|
| Rate for Payer: Vantage Medical Group Senior |
$24.55
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
IP
|
$53.44
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Adventist Health Commercial |
$10.69
|
| Rate for Payer: Adventist Health Commercial |
$10.49
|
| Rate for Payer: Blue Shield of California Commercial |
$41.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.54
|
| Rate for Payer: Blue Shield of California EPN |
$26.43
|
| Rate for Payer: Blue Shield of California EPN |
$26.93
|
| Rate for Payer: Cash Price |
$29.39
|
| Rate for Payer: Cash Price |
$28.84
|
| Rate for Payer: Central Health Plan Commercial |
$42.75
|
| Rate for Payer: Central Health Plan Commercial |
$41.95
|
| Rate for Payer: Cigna of CA HMO |
$36.71
|
| Rate for Payer: Cigna of CA HMO |
$37.41
|
| Rate for Payer: Cigna of CA PPO |
$36.71
|
| Rate for Payer: Cigna of CA PPO |
$37.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.38
|
| Rate for Payer: EPIC Health Plan Senior |
$20.98
|
| Rate for Payer: EPIC Health Plan Senior |
$21.38
|
| Rate for Payer: Galaxy Health WC |
$44.57
|
| Rate for Payer: Galaxy Health WC |
$45.42
|
| Rate for Payer: Global Benefits Group Commercial |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$31.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$40.08
|
| Rate for Payer: Networks By Design Commercial |
$26.22
|
| Rate for Payer: Networks By Design Commercial |
$26.72
|
| Rate for Payer: Prime Health Services Commercial |
$45.42
|
| Rate for Payer: Prime Health Services Commercial |
$44.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.06
|
| Rate for Payer: United Healthcare All Other HMO |
$19.52
|
| Rate for Payer: United Healthcare All Other HMO |
$19.16
|
| Rate for Payer: United Healthcare HMO Rider |
$18.74
|
| Rate for Payer: United Healthcare HMO Rider |
$19.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.50
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
OP
|
$52.44
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$48.26 |
| Rate for Payer: Adventist Health Commercial |
$10.49
|
| Rate for Payer: Adventist Health Commercial |
$10.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.60
|
| 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 |
$28.84
|
| Rate for Payer: Cash Price |
$28.84
|
| Rate for Payer: Cash Price |
$29.39
|
| Rate for Payer: Cash Price |
$29.39
|
| Rate for Payer: Central Health Plan Commercial |
$41.95
|
| Rate for Payer: Central Health Plan Commercial |
$42.75
|
| Rate for Payer: Cigna of CA HMO |
$37.41
|
| Rate for Payer: Cigna of CA HMO |
$36.71
|
| Rate for Payer: Cigna of CA PPO |
$37.41
|
| Rate for Payer: Cigna of CA PPO |
$36.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.98
|
| Rate for Payer: EPIC Health Plan Senior |
$20.98
|
| Rate for Payer: EPIC Health Plan Senior |
$21.38
|
| Rate for Payer: Galaxy Health WC |
$45.42
|
| Rate for Payer: Galaxy Health WC |
$44.57
|
| Rate for Payer: Global Benefits Group Commercial |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$31.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.58
|
| Rate for Payer: InnovAge PACE Commercial |
$26.22
|
| Rate for Payer: InnovAge PACE Commercial |
$26.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.71
|
| Rate for Payer: Multiplan Commercial |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$40.08
|
| Rate for Payer: Networks By Design Commercial |
$26.72
|
| Rate for Payer: Networks By Design Commercial |
$26.22
|
| Rate for Payer: Prime Health Services Commercial |
$45.42
|
| Rate for Payer: Prime Health Services Commercial |
$44.57
|
| Rate for Payer: Riverside University Health System MISP |
$20.98
|
| Rate for Payer: Riverside University Health System MISP |
$21.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.68
|
| Rate for Payer: United Healthcare All Other HMO |
$19.16
|
| Rate for Payer: United Healthcare All Other HMO |
$19.52
|
| Rate for Payer: United Healthcare HMO Rider |
$18.74
|
| Rate for Payer: United Healthcare HMO Rider |
$19.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.42
|
| Rate for Payer: Vantage Medical Group Senior |
$44.57
|
| Rate for Payer: Vantage Medical Group Senior |
$45.42
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
IP
|
$104.93
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$94.44 |
| Rate for Payer: Adventist Health Commercial |
$20.99
|
| Rate for Payer: Blue Shield of California Commercial |
$81.11
|
| Rate for Payer: Blue Shield of California EPN |
$52.88
|
| Rate for Payer: Cash Price |
$57.71
|
| Rate for Payer: Central Health Plan Commercial |
$83.94
|
| Rate for Payer: Cigna of CA HMO |
$73.45
|
| Rate for Payer: Cigna of CA PPO |
$73.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.97
|
| Rate for Payer: EPIC Health Plan Senior |
$41.97
|
| Rate for Payer: Galaxy Health WC |
$89.19
|
| Rate for Payer: Global Benefits Group Commercial |
$62.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.99
|
| Rate for Payer: Multiplan Commercial |
$78.70
|
| Rate for Payer: Networks By Design Commercial |
$52.47
|
| Rate for Payer: Prime Health Services Commercial |
$89.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.38
|
| Rate for Payer: United Healthcare All Other HMO |
$38.33
|
| Rate for Payer: United Healthcare HMO Rider |
$37.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.36
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
OP
|
$104.93
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$94.44 |
| Rate for Payer: Adventist Health Commercial |
$20.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.60
|
| 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 |
$57.71
|
| Rate for Payer: Cash Price |
$57.71
|
| Rate for Payer: Central Health Plan Commercial |
$83.94
|
| Rate for Payer: Cigna of CA HMO |
$73.45
|
| Rate for Payer: Cigna of CA PPO |
$73.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.97
|
| Rate for Payer: EPIC Health Plan Senior |
$41.97
|
| Rate for Payer: Galaxy Health WC |
$89.19
|
| Rate for Payer: Global Benefits Group Commercial |
$62.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.58
|
| Rate for Payer: InnovAge PACE Commercial |
$52.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.45
|
| Rate for Payer: Multiplan Commercial |
$78.70
|
| Rate for Payer: Networks By Design Commercial |
$52.47
|
| Rate for Payer: Prime Health Services Commercial |
$89.19
|
| Rate for Payer: Riverside University Health System MISP |
$41.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.38
|
| Rate for Payer: United Healthcare All Other HMO |
$38.33
|
| Rate for Payer: United Healthcare HMO Rider |
$37.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.19
|
| Rate for Payer: Vantage Medical Group Senior |
$89.19
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 51672-1292-1
|
| 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 |
$4.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$3.46
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.90
|
| 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
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 51672-1292-1
|
| 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 |
$3.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$3.46
|
| 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: 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: InnovAge PACE Commercial |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.41
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
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 |
$1.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7.70
|
| Rate for Payer: Blue Shield of California Commercial |
$5.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$5.02
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Central Health Plan Commercial |
$7.97
|
| Rate for Payer: Central Health Plan Commercial |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$5.34
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$5.34
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$6.49
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Global Benefits Group Commercial |
$4.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$3.81
|
| 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 |
$6.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.86
|
| 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 |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION. [4082191]
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| 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 |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Central Health Plan Commercial |
$6.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.97
|
| Rate for Payer: Cigna of CA HMO |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$5.34
|
| Rate for Payer: Cigna of CA PPO |
$6.97
|
| Rate for Payer: Cigna of CA PPO |
$5.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Galaxy Health WC |
$6.49
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Global Benefits Group Commercial |
$4.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.87
|
| 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: InnovAge PACE Commercial |
$3.81
|
| Rate for Payer: InnovAge PACE Commercial |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.34
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Networks By Design Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$3.81
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$6.49
|
| Rate for Payer: Riverside University Health System MISP |
$3.05
|
| Rate for Payer: Riverside University Health System MISP |
$3.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$3.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.49
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
|
|
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 |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.74
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.08
|
| 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 |
$8.64 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.02
|
| 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 |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| 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 |
$2.74
|
| Rate for Payer: Cash Price |
$2.74
|
| 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: 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: InnovAge PACE Commercial |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.49
|
| Rate for Payer: Molina Healthcare of CA 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
|
$0.38
|
|
|
Service Code
|
NDC 42858-304-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 42858-304-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: InnovAge PACE Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Riverside University Health System MISP |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 0054-0386-63
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: InnovAge PACE Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 0054-0386-63
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 9999-9102-25
|
| 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 |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.57
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.64
|
| 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
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 9999-9102-25
|
| 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: Aetna of CA HMO/PPO |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.57
|
| 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: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.88
|
| 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: InnovAge PACE Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.73
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
