|
LIDOCAINE 4 % TOPICAL PATCH [110425]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 0536-1202-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Central Health Plan Commercial |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Senior |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.35
|
| Rate for Payer: InnovAge PACE Commercial |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.27
|
| Rate for Payer: Riverside University Health System MISP |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1.27
|
|
|
LIDOCAINE 4 % TOPICAL PATCH [110425]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 0121-0970-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: InnovAge PACE Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
LIDOCAINE 5 % TOPICAL GEL [154443]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 63135-581-10
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.60
|
| Rate for Payer: InnovAge PACE Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
| Rate for Payer: Riverside University Health System MISP |
$0.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
LIDOCAINE 5 % TOPICAL GEL [154443]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 63135-581-10
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
IP
|
$0.85
|
|
|
Service Code
|
NDC 51672-3020-9
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.72
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
IP
|
$8.13
|
|
|
Service Code
|
NDC 0168-0204-37
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$4.47
|
| Rate for Payer: Central Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.25
|
| Rate for Payer: EPIC Health Plan Senior |
$3.25
|
| Rate for Payer: Galaxy Health WC |
$6.91
|
| Rate for Payer: Global Benefits Group Commercial |
$4.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$6.10
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Prime Health Services Commercial |
$6.91
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 51672-3020-2
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$0.77
|
| Rate for Payer: Cigna of CA PPO |
$0.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: InnovAge PACE Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
OP
|
$8.13
|
|
|
Service Code
|
NDC 0168-0204-37
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.24
|
| Rate for Payer: Cash Price |
$4.47
|
| Rate for Payer: Central Health Plan Commercial |
$6.50
|
| Rate for Payer: Cigna of CA HMO |
$5.20
|
| Rate for Payer: Cigna of CA PPO |
$6.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.25
|
| Rate for Payer: EPIC Health Plan Senior |
$3.25
|
| Rate for Payer: Galaxy Health WC |
$6.91
|
| Rate for Payer: Global Benefits Group Commercial |
$4.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.32
|
| Rate for Payer: InnovAge PACE Commercial |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$6.10
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Prime Health Services Commercial |
$6.91
|
| Rate for Payer: Riverside University Health System MISP |
$3.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.91
|
| Rate for Payer: Vantage Medical Group Senior |
$6.91
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 51672-3020-2
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 33342-405-30
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| 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 |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| 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: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$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: 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 |
$0.19
|
| 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 |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System 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 Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 68462-418-20
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.84
|
| Rate for Payer: InnovAge PACE Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
| Rate for Payer: Riverside University Health System MISP |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Vantage Medical Group Senior |
$0.79
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
NDC 51672-3020-9
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.77
|
| Rate for Payer: InnovAge PACE Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.72
|
| Rate for Payer: Riverside University Health System MISP |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Vantage Medical Group Senior |
$0.72
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 68462-418-20
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT [154444]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
NDC 33342-405-30
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| 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
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
IP
|
$9.86
|
|
|
Service Code
|
NDC 0378-9055-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7.62
|
| Rate for Payer: Blue Shield of California EPN |
$4.97
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Central Health Plan Commercial |
$7.89
|
| Rate for Payer: Cigna of CA HMO |
$6.90
|
| Rate for Payer: Cigna of CA PPO |
$6.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.39
|
| Rate for Payer: Networks By Design Commercial |
$6.41
|
| Rate for Payer: Prime Health Services Commercial |
$8.38
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
NDC 0603-1880-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.33
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
NDC 0603-1880-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: InnovAge PACE Commercial |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.51
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.33
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
NDC 0603-1880-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.33
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
OP
|
$9.86
|
|
|
Service Code
|
NDC 0378-9055-93
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$6.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.93
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Central Health Plan Commercial |
$7.89
|
| Rate for Payer: Cigna of CA HMO |
$6.90
|
| Rate for Payer: Cigna of CA PPO |
$6.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.87
|
| Rate for Payer: InnovAge PACE Commercial |
$4.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$7.39
|
| Rate for Payer: Networks By Design Commercial |
$6.41
|
| Rate for Payer: Prime Health Services Commercial |
$8.38
|
| Rate for Payer: Riverside University Health System MISP |
$3.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.93
|
| Rate for Payer: United Healthcare All Other HMO |
$4.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8.38
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
NDC 0603-1880-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: InnovAge PACE Commercial |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.51
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.33
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
NDC 0591-3525-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.33
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
IP
|
$9.86
|
|
|
Service Code
|
NDC 0378-9055-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7.62
|
| Rate for Payer: Blue Shield of California EPN |
$4.97
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Central Health Plan Commercial |
$7.89
|
| Rate for Payer: Cigna of CA HMO |
$6.90
|
| Rate for Payer: Cigna of CA PPO |
$6.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.39
|
| Rate for Payer: Networks By Design Commercial |
$6.41
|
| Rate for Payer: Prime Health Services Commercial |
$8.38
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
OP
|
$9.86
|
|
|
Service Code
|
NDC 0378-9055-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$6.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.93
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Central Health Plan Commercial |
$7.89
|
| Rate for Payer: Cigna of CA HMO |
$6.90
|
| Rate for Payer: Cigna of CA PPO |
$6.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.87
|
| Rate for Payer: InnovAge PACE Commercial |
$4.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$7.39
|
| Rate for Payer: Networks By Design Commercial |
$6.41
|
| Rate for Payer: Prime Health Services Commercial |
$8.38
|
| Rate for Payer: Riverside University Health System MISP |
$3.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.93
|
| Rate for Payer: United Healthcare All Other HMO |
$4.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8.38
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
NDC 0591-3525-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: InnovAge PACE Commercial |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.51
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.33
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
LIDOCAINE (8MG/ML) 2 G/250 ML D5W BAG - CODE [4080568]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| 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 |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| 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 |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| 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
|
|
