|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [1262]
|
Facility
|
IP
|
$23.48
|
|
|
Service Code
|
NDC 0517-2502-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$21.13 |
| Rate for Payer: Adventist Health Commercial |
$4.70
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.83
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Central Health Plan Commercial |
$18.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.39
|
| Rate for Payer: EPIC Health Plan Senior |
$9.39
|
| Rate for Payer: Galaxy Health WC |
$19.96
|
| Rate for Payer: Global Benefits Group Commercial |
$14.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$17.61
|
| Rate for Payer: Networks By Design Commercial |
$15.26
|
| Rate for Payer: Prime Health Services Commercial |
$19.96
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [1262]
|
Facility
|
IP
|
$23.48
|
|
|
Service Code
|
NDC 0517-2502-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$21.13 |
| Rate for Payer: Adventist Health Commercial |
$4.70
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.83
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Central Health Plan Commercial |
$18.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.39
|
| Rate for Payer: EPIC Health Plan Senior |
$9.39
|
| Rate for Payer: Galaxy Health WC |
$19.96
|
| Rate for Payer: Global Benefits Group Commercial |
$14.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$17.61
|
| Rate for Payer: Networks By Design Commercial |
$15.26
|
| Rate for Payer: Prime Health Services Commercial |
$19.96
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [1262]
|
Facility
|
OP
|
$23.48
|
|
|
Service Code
|
NDC 0517-2502-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$21.13 |
| Rate for Payer: Adventist Health Commercial |
$4.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.79
|
| Rate for Payer: Blue Shield of California Commercial |
$14.35
|
| Rate for Payer: Blue Shield of California EPN |
$9.37
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Central Health Plan Commercial |
$18.78
|
| Rate for Payer: Cigna of CA HMO |
$15.03
|
| Rate for Payer: Cigna of CA PPO |
$17.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.39
|
| Rate for Payer: EPIC Health Plan Senior |
$9.39
|
| Rate for Payer: Galaxy Health WC |
$19.96
|
| Rate for Payer: Global Benefits Group Commercial |
$14.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.13
|
| Rate for Payer: InnovAge PACE Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.44
|
| Rate for Payer: Multiplan Commercial |
$17.61
|
| Rate for Payer: Networks By Design Commercial |
$15.26
|
| Rate for Payer: Prime Health Services Commercial |
$19.96
|
| Rate for Payer: Riverside University Health System MISP |
$9.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.74
|
| Rate for Payer: United Healthcare All Other HMO |
$11.74
|
| Rate for Payer: United Healthcare HMO Rider |
$11.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.96
|
| Rate for Payer: Vantage Medical Group Senior |
$19.96
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION [78879]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0904-2533-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION [78879]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0904-2533-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION [78879]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0395-0413-96
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION [78879]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0395-0413-96
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM [16034]
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 68462-501-65
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.97
|
| Rate for Payer: InnovAge PACE Commercial |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
| Rate for Payer: Riverside University Health System MISP |
$1.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3.75
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM [16034]
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 68462-501-65
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.41
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$3.09
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Senior |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.75
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL OINTMENT [12244]
|
Facility
|
IP
|
$6.03
|
|
|
Service Code
|
NDC 66993-878-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$4.66
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Central Health Plan Commercial |
$4.82
|
| Rate for Payer: Cigna of CA HMO |
$4.22
|
| Rate for Payer: Cigna of CA PPO |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: EPIC Health Plan Senior |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.52
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL OINTMENT [12244]
|
Facility
|
OP
|
$6.03
|
|
|
Service Code
|
NDC 66993-878-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: Blue Shield of California Commercial |
$3.68
|
| Rate for Payer: Blue Shield of California EPN |
$2.41
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Central Health Plan Commercial |
$4.82
|
| Rate for Payer: Cigna of CA HMO |
$4.22
|
| Rate for Payer: Cigna of CA PPO |
$4.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: EPIC Health Plan Senior |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.43
|
| Rate for Payer: InnovAge PACE Commercial |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$4.52
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
| Rate for Payer: Riverside University Health System MISP |
$2.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL SUSPENSION [91914]
|
Facility
|
IP
|
$26.04
|
|
|
Service Code
|
NDC 50222-501-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Blue Shield of California Commercial |
$20.13
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Central Health Plan Commercial |
$20.83
|
| Rate for Payer: Cigna of CA HMO |
$18.23
|
| Rate for Payer: Cigna of CA PPO |
$18.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.42
|
| Rate for Payer: EPIC Health Plan Senior |
$10.42
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: Networks By Design Commercial |
$16.93
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL SUSPENSION [91914]
|
Facility
|
OP
|
$26.04
|
|
|
Service Code
|
NDC 50222-501-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.29
|
| Rate for Payer: Blue Shield of California Commercial |
$15.91
|
| Rate for Payer: Blue Shield of California EPN |
$10.39
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Central Health Plan Commercial |
$20.83
|
| Rate for Payer: Cigna of CA HMO |
$18.23
|
| Rate for Payer: Cigna of CA PPO |
$18.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.42
|
| Rate for Payer: EPIC Health Plan Senior |
$10.42
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.44
|
| Rate for Payer: InnovAge PACE Commercial |
$13.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.23
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: Networks By Design Commercial |
$16.93
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Riverside University Health System MISP |
$10.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.02
|
| Rate for Payer: United Healthcare All Other HMO |
$13.02
|
| Rate for Payer: United Healthcare HMO Rider |
$13.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]
|
Facility
|
IP
|
$24.28
|
|
|
Service Code
|
NDC 60505-0823-6
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Adventist Health Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$18.77
|
| Rate for Payer: Blue Shield of California EPN |
$12.24
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Central Health Plan Commercial |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$17.00
|
| Rate for Payer: Cigna of CA PPO |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.64
|
| Rate for Payer: Global Benefits Group Commercial |
$14.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$18.21
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.64
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]
|
Facility
|
OP
|
$24.28
|
|
|
Service Code
|
NDC 60505-0823-6
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Adventist Health Commercial |
$4.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.26
|
| Rate for Payer: Blue Shield of California Commercial |
$14.84
|
| Rate for Payer: Blue Shield of California EPN |
$9.69
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Central Health Plan Commercial |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$17.00
|
| Rate for Payer: Cigna of CA PPO |
$17.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.64
|
| Rate for Payer: Global Benefits Group Commercial |
$14.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.85
|
| Rate for Payer: InnovAge PACE Commercial |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$18.21
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.64
|
| Rate for Payer: Riverside University Health System MISP |
$9.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.64
|
| Rate for Payer: Vantage Medical Group Senior |
$20.64
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$3,208.63 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$835.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$835.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$364.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,044.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,044.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$919.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$919.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$919.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$919.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,759.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,759.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$539.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$539.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,208.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,208.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,916.94
|
| Rate for Payer: Blue Shield of California EPN |
$2,916.94
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Central Health Plan Commercial |
$480.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$420.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$420.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,044.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,044.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$919.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$919.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$919.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$919.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.34
|
| Rate for Payer: EPIC Health Plan Senior |
$835.80
|
| Rate for Payer: EPIC Health Plan Senior |
$835.80
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,370.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,370.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,972.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,972.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$835.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$835.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,253.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,253.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,179.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,179.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,119.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,119.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,119.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,119.98
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$450.00
|
| Rate for Payer: Networks By Design Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$835.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$835.80
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Prime Health Services Medicare |
$885.95
|
| Rate for Payer: Prime Health Services Medicare |
$885.95
|
| Rate for Payer: Riverside University Health System MISP |
$919.38
|
| Rate for Payer: Riverside University Health System MISP |
$919.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.18
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare All Other HMO |
$219.18
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare HMO Rider |
$214.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$835.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$835.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,044.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,044.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$919.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$919.38
|
| Rate for Payer: Vantage Medical Group Senior |
$919.38
|
| Rate for Payer: Vantage Medical Group Senior |
$919.38
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Blue Shield of California Commercial |
$463.80
|
| Rate for Payer: Blue Shield of California Commercial |
$371.04
|
| Rate for Payer: Blue Shield of California EPN |
$241.92
|
| Rate for Payer: Blue Shield of California EPN |
$302.40
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Central Health Plan Commercial |
$480.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$420.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$420.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$240.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$371.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$450.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$300.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.18
|
| Rate for Payer: United Healthcare All Other HMO |
$219.18
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare HMO Rider |
$214.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.50
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 0054-0007-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Central Health Plan Commercial |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: InnovAge PACE Commercial |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
| Rate for Payer: Riverside University Health System MISP |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Vantage Medical Group Senior |
$0.97
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 60687-345-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: InnovAge PACE Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
| Rate for Payer: Riverside University Health System MISP |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 64380-723-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| 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 |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: InnovAge PACE Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| 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 Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 69452-207-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| 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 |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 69452-207-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| 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 |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 60687-345-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 62756-967-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| 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 |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 64380-723-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| 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 |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
