|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
IP
|
$3.59
|
|
|
Service Code
|
NDC 0591-3525-30
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.62
|
| 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: 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: 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 |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Blue Shield of California Commercial |
$7.40
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$4.44
|
| 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: 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: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.40
|
| 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 0378-9055-93
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.83
|
| Rate for Payer: BCBS Transplant Transplant |
$5.92
|
| Rate for Payer: Blue Shield of California Commercial |
$6.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$4.44
|
| 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: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$7.40
|
| Rate for Payer: IEHP medi-cal |
$3.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.40
|
| Rate for Payer: Networks By Design Commercial |
$6.41
|
| Rate for Payer: Prime Health Services Commercial |
$8.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.92
|
| Rate for Payer: Riverside University Health 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 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 |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.12
|
| Rate for Payer: BCBS Transplant Transplant |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.62
|
| 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: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2.69
|
| Rate for Payer: IEHP medi-cal |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: Riverside University Health 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 |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| 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
|
$2.60
|
|
|
Service Code
|
NDC 42858-118-30
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
OP
|
$3.59
|
|
|
Service Code
|
NDC 0603-1880-10
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.12
|
| Rate for Payer: BCBS Transplant Transplant |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.62
|
| 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: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2.69
|
| Rate for Payer: IEHP medi-cal |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: Riverside University Health 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 |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| 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 0603-1880-10
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.62
|
| 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: 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: 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 0591-3525-30
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.12
|
| Rate for Payer: BCBS Transplant Transplant |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.62
|
| 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: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2.69
|
| Rate for Payer: IEHP medi-cal |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: Riverside University Health 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 |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| 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
OP
|
$2.60
|
|
|
Service Code
|
NDC 42858-118-30
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.08
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.95
|
| Rate for Payer: IEHP medi-cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: Riverside University Health MISP |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
IP
|
$31.81
|
|
|
Service Code
|
NDC 63481-687-01
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Blue Shield of California Commercial |
$23.86
|
| Rate for Payer: Blue Shield of California EPN |
$16.99
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Central Health Plan Commercial |
$25.45
|
| Rate for Payer: Cigna of CA HMO |
$22.27
|
| Rate for Payer: Cigna of CA PPO |
$22.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
| Rate for Payer: Galaxy Health WC |
$27.04
|
| Rate for Payer: Global Benefits Group Commercial |
$19.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$23.86
|
| Rate for Payer: Networks By Design Commercial |
$20.68
|
| Rate for Payer: Prime Health Services Commercial |
$27.04
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
OP
|
$31.81
|
|
|
Service Code
|
NDC 63481-687-01
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.79
|
| Rate for Payer: BCBS Transplant Transplant |
$19.09
|
| Rate for Payer: Blue Shield of California Commercial |
$20.01
|
| Rate for Payer: Blue Shield of California EPN |
$15.56
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Central Health Plan Commercial |
$25.45
|
| Rate for Payer: Cigna of CA HMO |
$22.27
|
| Rate for Payer: Cigna of CA PPO |
$22.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.72
|
| Rate for Payer: Galaxy Health WC |
$27.04
|
| Rate for Payer: Global Benefits Group Commercial |
$19.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.86
|
| Rate for Payer: IEHP medi-cal |
$11.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$23.86
|
| Rate for Payer: Networks By Design Commercial |
$20.68
|
| Rate for Payer: Prime Health Services Commercial |
$27.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19.09
|
| Rate for Payer: Riverside University Health MISP |
$12.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.90
|
| Rate for Payer: United Healthcare All Other HMO |
$15.90
|
| Rate for Payer: United Healthcare HMO Rider |
$15.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.04
|
| Rate for Payer: Vantage Medical Group Senior |
$27.04
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
IP
|
$31.81
|
|
|
Service Code
|
NDC 63481-687-06
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Blue Shield of California Commercial |
$23.86
|
| Rate for Payer: Blue Shield of California EPN |
$16.99
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Central Health Plan Commercial |
$25.45
|
| Rate for Payer: Cigna of CA HMO |
$22.27
|
| Rate for Payer: Cigna of CA PPO |
$22.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
| Rate for Payer: Galaxy Health WC |
$27.04
|
| Rate for Payer: Global Benefits Group Commercial |
$19.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$23.86
|
| Rate for Payer: Networks By Design Commercial |
$20.68
|
| Rate for Payer: Prime Health Services Commercial |
$27.04
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
OP
|
$31.81
|
|
|
Service Code
|
NDC 63481-687-06
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.79
|
| Rate for Payer: BCBS Transplant Transplant |
$19.09
|
| Rate for Payer: Blue Shield of California Commercial |
$20.01
|
| Rate for Payer: Blue Shield of California EPN |
$15.56
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Central Health Plan Commercial |
$25.45
|
| Rate for Payer: Cigna of CA HMO |
$22.27
|
| Rate for Payer: Cigna of CA PPO |
$22.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.72
|
| Rate for Payer: Galaxy Health WC |
$27.04
|
| Rate for Payer: Global Benefits Group Commercial |
$19.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.86
|
| Rate for Payer: IEHP medi-cal |
$11.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$23.86
|
| Rate for Payer: Networks By Design Commercial |
$20.68
|
| Rate for Payer: Prime Health Services Commercial |
$27.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19.09
|
| Rate for Payer: Riverside University Health MISP |
$12.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.90
|
| Rate for Payer: United Healthcare All Other HMO |
$15.90
|
| Rate for Payer: United Healthcare HMO Rider |
$15.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.04
|
| Rate for Payer: Vantage Medical Group Senior |
$27.04
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
IP
|
$9.86
|
|
|
Service Code
|
NDC 0378-9055-93
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Blue Shield of California Commercial |
$7.40
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$4.44
|
| 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: 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: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.40
|
| 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 |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.83
|
| Rate for Payer: BCBS Transplant Transplant |
$5.92
|
| Rate for Payer: Blue Shield of California Commercial |
$6.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.82
|
| Rate for Payer: Cash Price |
$4.44
|
| 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: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$7.40
|
| Rate for Payer: IEHP medi-cal |
$3.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.40
|
| Rate for Payer: Networks By Design Commercial |
$6.41
|
| Rate for Payer: Prime Health Services Commercial |
$8.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.92
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$8.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8.38
|
|
|
LIDOCAINE 5 % TOPICAL PATCH [28203]
|
Facility
IP
|
$3.59
|
|
|
Service Code
|
NDC 0603-1880-16
|
| Hospital Charge Code |
1743696
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.62
|
| 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: 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: 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 (8MG/ML) 2 G/250 ML D5W BAG - CODE [4080568]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 Transplant |
$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: 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
|
|
|
LIDOCAINE (8MG/ML) 2 G/250 ML D5W BAG - CODE [4080568]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
1771168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$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: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| 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: Riverside University Health MISP |
$0.02
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [14870]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 0409-3177-01
|
| Hospital Charge Code |
1720426
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [14870]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 0409-3177-16
|
| Hospital Charge Code |
1720426
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [14870]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 0409-3177-16
|
| Hospital Charge Code |
1720426
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [14870]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 0409-3177-01
|
| Hospital Charge Code |
1720426
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJECTION. [4081101]
|
Facility
OP
|
$0.21
|
|
|
Service Code
|
NDC 0409-3182-02
|
| Hospital Charge Code |
1721211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.16
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJECTION. [4081101]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
NDC 0409-3182-01
|
| Hospital Charge Code |
1720631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: BCBS Transplant Transplant |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.15
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJECTION. [4081101]
|
Facility
IP
|
$0.21
|
|
|
Service Code
|
NDC 0409-3182-02
|
| Hospital Charge Code |
1721211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
