|
KETAMINE INFUSION (STRAIGHT DRAW 10 MG/ML) [4081976]
|
Facility
IP
|
$1.16
|
|
|
Service Code
|
NDC 67457-181-20
|
| Hospital Charge Code |
NDG4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
KETOCONAZOLE 200 MG TABLET [10369]
|
Facility
OP
|
$2.66
|
|
|
Service Code
|
NDC 51672-4026-1
|
| Hospital Charge Code |
1710264
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.26
|
| 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 |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.57
|
| Rate for Payer: BCBS Transplant Transplant |
$1.60
|
| 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 |
$1.20
|
| Rate for Payer: Central Health Plan Commercial |
$2.13
|
| 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 |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.06
|
| Rate for Payer: Galaxy Health WC |
$2.26
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.00
|
| 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 |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$2.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.60
|
| Rate for Payer: Riverside University Health MISP |
$1.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2.26
|
|
|
KETOCONAZOLE 200 MG TABLET [10369]
|
Facility
IP
|
$2.59
|
|
|
Service Code
|
NDC 51672-4026-6
|
| Hospital Charge Code |
1710264
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.38
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$1.81
|
| Rate for Payer: Cigna of CA PPO |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$2.20
|
|
|
KETOCONAZOLE 200 MG TABLET [10369]
|
Facility
OP
|
$1.26
|
|
|
Service Code
|
NDC 35573-433-30
|
| Hospital Charge Code |
1710264
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: BCBS Transplant Transplant |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Central Health Plan Commercial |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.95
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: Riverside University Health MISP |
$0.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
|
|
KETOCONAZOLE 200 MG TABLET [10369]
|
Facility
IP
|
$1.26
|
|
|
Service Code
|
NDC 35573-433-30
|
| Hospital Charge Code |
1710264
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Central Health Plan Commercial |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
|
|
KETOCONAZOLE 200 MG TABLET [10369]
|
Facility
IP
|
$2.66
|
|
|
Service Code
|
NDC 51672-4026-1
|
| Hospital Charge Code |
1710264
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Central Health Plan Commercial |
$2.13
|
| 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 |
$2.26
|
| Rate for Payer: Global Benefits Group Commercial |
$1.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.39
|
| 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 |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$2.26
|
|
|
KETOCONAZOLE 200 MG TABLET [10369]
|
Facility
OP
|
$2.59
|
|
|
Service Code
|
NDC 51672-4026-6
|
| Hospital Charge Code |
1710264
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.53
|
| Rate for Payer: BCBS Transplant Transplant |
$1.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$1.81
|
| Rate for Payer: Cigna of CA PPO |
$1.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.94
|
| Rate for Payer: IEHP medi-cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$2.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.55
|
| Rate for Payer: Riverside University Health MISP |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2.20
|
|
|
KETOCONAZOLE 2 % SHAMPOO [14132]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 45802-465-64
|
| Hospital Charge Code |
1774007
|
|
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
|
|
|
KETOCONAZOLE 2 % SHAMPOO [14132]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
NDC 63646-010-04
|
| Hospital Charge Code |
1774007
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: BCBS Transplant Transplant |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.15
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
KETOCONAZOLE 2 % SHAMPOO [14132]
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 45802-465-64
|
| Hospital Charge Code |
1774007
|
|
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
|
|
|
KETOCONAZOLE 2 % SHAMPOO [14132]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 63646-010-04
|
| Hospital Charge Code |
1774007
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM [10368]
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
NDC 51672-1298-2
|
| Hospital Charge Code |
1743493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM [10368]
|
Facility
IP
|
$1.67
|
|
|
Service Code
|
NDC 0093-3219-30
|
| Hospital Charge Code |
1743493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.17
|
| Rate for Payer: Cigna of CA PPO |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.42
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.42
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM [10368]
|
Facility
OP
|
$1.67
|
|
|
Service Code
|
NDC 0093-3219-30
|
| Hospital Charge Code |
1743493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.17
|
| Rate for Payer: Cigna of CA PPO |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.42
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.25
|
| Rate for Payer: IEHP medi-cal |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: Riverside University Health MISP |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.42
|
| Rate for Payer: Vantage Medical Group Senior |
$1.42
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM [10368]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 0168-0099-30
|
| Hospital Charge Code |
1743493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM [10368]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 0168-0099-30
|
| Hospital Charge Code |
1743493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM [10368]
|
Facility
OP
|
$1.52
|
|
|
Service Code
|
NDC 51672-1298-2
|
| Hospital Charge Code |
1743493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: BCBS Transplant Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.14
|
| Rate for Payer: IEHP medi-cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: Riverside University Health MISP |
$0.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: Vantage Medical Group Senior |
$1.29
|
|
|
KETOCONAZOLE ORAL SUSPENSION COMPOUND 20 MG/ML [4080285]
|
Facility
OP
|
$0.31
|
|
|
Service Code
|
NDC 9994-0802-85
|
| Hospital Charge Code |
1715910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: Riverside University Health MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
KETOCONAZOLE ORAL SUSPENSION COMPOUND 20 MG/ML [4080285]
|
Facility
IP
|
$0.31
|
|
|
Service Code
|
NDC 9994-0802-85
|
| Hospital Charge Code |
1715910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
KETOROLAC 0.5 % EYE DROPS [19733]
|
Facility
IP
|
$7.69
|
|
|
Service Code
|
NDC 17478-209-10
|
| Hospital Charge Code |
1740309
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Central Health Plan Commercial |
$6.15
|
| Rate for Payer: Cigna of CA HMO |
$5.38
|
| Rate for Payer: Cigna of CA PPO |
$5.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Global Benefits Group Commercial |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Networks By Design Commercial |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$6.54
|
|
|
KETOROLAC 0.5 % EYE DROPS [19733]
|
Facility
OP
|
$7.69
|
|
|
Service Code
|
NDC 17478-209-10
|
| Hospital Charge Code |
1740309
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.54
|
| Rate for Payer: BCBS Transplant Transplant |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.76
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Central Health Plan Commercial |
$6.15
|
| Rate for Payer: Cigna of CA HMO |
$5.38
|
| Rate for Payer: Cigna of CA PPO |
$5.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Global Benefits Group Commercial |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.77
|
| Rate for Payer: IEHP medi-cal |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Networks By Design Commercial |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$6.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.61
|
| Rate for Payer: Riverside University Health MISP |
$3.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.54
|
| Rate for Payer: Vantage Medical Group Senior |
$6.54
|
|
|
KETOROLAC 0.5 % EYE DROPS [19733]
|
Facility
IP
|
$7.69
|
|
|
Service Code
|
NDC 60505-1003-1
|
| Hospital Charge Code |
1740309
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Central Health Plan Commercial |
$6.15
|
| Rate for Payer: Cigna of CA HMO |
$5.38
|
| Rate for Payer: Cigna of CA PPO |
$5.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Global Benefits Group Commercial |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Networks By Design Commercial |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$6.54
|
|
|
KETOROLAC 0.5 % EYE DROPS [19733]
|
Facility
OP
|
$7.69
|
|
|
Service Code
|
NDC 60505-1003-1
|
| Hospital Charge Code |
1740309
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.54
|
| Rate for Payer: BCBS Transplant Transplant |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.76
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Central Health Plan Commercial |
$6.15
|
| Rate for Payer: Cigna of CA HMO |
$5.38
|
| Rate for Payer: Cigna of CA PPO |
$5.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Global Benefits Group Commercial |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.77
|
| Rate for Payer: IEHP medi-cal |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Networks By Design Commercial |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$6.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.61
|
| Rate for Payer: Riverside University Health MISP |
$3.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.54
|
| Rate for Payer: Vantage Medical Group Senior |
$6.54
|
|
|
KETOROLAC 0.5 % EYE DROPS [19733]
|
Facility
IP
|
$6.72
|
|
|
Service Code
|
NDC 61314-126-05
|
| Hospital Charge Code |
1740309
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: Cigna of CA HMO |
$4.70
|
| Rate for Payer: Cigna of CA PPO |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
|
|
KETOROLAC 0.5 % EYE DROPS [19733]
|
Facility
OP
|
$6.72
|
|
|
Service Code
|
NDC 61314-126-05
|
| Hospital Charge Code |
1740309
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.97
|
| Rate for Payer: BCBS Transplant Transplant |
$4.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4.23
|
| Rate for Payer: Blue Shield of California EPN |
$3.29
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: Cigna of CA HMO |
$4.70
|
| Rate for Payer: Cigna of CA PPO |
$4.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.04
|
| Rate for Payer: IEHP medi-cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.03
|
| Rate for Payer: Riverside University Health MISP |
$2.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.71
|
| Rate for Payer: Vantage Medical Group Senior |
$5.71
|
|
