|
MEXILETINE ORAL SUSPENSION COMPOUND 10 MG/ML [4081649]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 9994-0816-49
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION [41144]
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Blue Shield of California Commercial |
$69.38
|
| Rate for Payer: Blue Shield of California EPN |
$45.24
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Central Health Plan Commercial |
$71.81
|
| Rate for Payer: Cigna of CA HMO |
$62.83
|
| Rate for Payer: Cigna of CA PPO |
$62.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.90
|
| Rate for Payer: EPIC Health Plan Senior |
$35.90
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Multiplan Commercial |
$67.32
|
| Rate for Payer: Networks By Design Commercial |
$44.88
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.69
|
| Rate for Payer: United Healthcare All Other HMO |
$32.79
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.40
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION [41144]
|
Facility
|
IP
|
$32.66
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.39 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Adventist Health Commercial |
$22.44
|
| Rate for Payer: Blue Shield of California Commercial |
$25.25
|
| Rate for Payer: Blue Shield of California Commercial |
$86.73
|
| Rate for Payer: Blue Shield of California Commercial |
$69.38
|
| Rate for Payer: Blue Shield of California Commercial |
$36.18
|
| Rate for Payer: Blue Shield of California EPN |
$16.46
|
| Rate for Payer: Blue Shield of California EPN |
$56.55
|
| Rate for Payer: Blue Shield of California EPN |
$23.59
|
| Rate for Payer: Blue Shield of California EPN |
$45.24
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$25.74
|
| Rate for Payer: Cash Price |
$17.97
|
| Rate for Payer: Central Health Plan Commercial |
$71.81
|
| Rate for Payer: Central Health Plan Commercial |
$26.13
|
| Rate for Payer: Central Health Plan Commercial |
$89.76
|
| Rate for Payer: Central Health Plan Commercial |
$37.44
|
| Rate for Payer: Cigna of CA HMO |
$22.86
|
| Rate for Payer: Cigna of CA HMO |
$32.76
|
| Rate for Payer: Cigna of CA HMO |
$62.83
|
| Rate for Payer: Cigna of CA HMO |
$78.54
|
| Rate for Payer: Cigna of CA PPO |
$78.54
|
| Rate for Payer: Cigna of CA PPO |
$22.86
|
| Rate for Payer: Cigna of CA PPO |
$32.76
|
| Rate for Payer: Cigna of CA PPO |
$62.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$35.90
|
| Rate for Payer: EPIC Health Plan Senior |
$18.72
|
| Rate for Payer: EPIC Health Plan Senior |
$44.88
|
| Rate for Payer: Galaxy Health WC |
$27.76
|
| Rate for Payer: Galaxy Health WC |
$39.78
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Galaxy Health WC |
$95.37
|
| Rate for Payer: Global Benefits Group Commercial |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$67.32
|
| Rate for Payer: Global Benefits Group Commercial |
$19.60
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$67.32
|
| Rate for Payer: Multiplan Commercial |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$84.15
|
| Rate for Payer: Multiplan Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$44.88
|
| Rate for Payer: Networks By Design Commercial |
$56.10
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$16.33
|
| Rate for Payer: Prime Health Services Commercial |
$39.78
|
| Rate for Payer: Prime Health Services Commercial |
$27.76
|
| Rate for Payer: Prime Health Services Commercial |
$95.37
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.26
|
| Rate for Payer: United Healthcare All Other HMO |
$11.93
|
| Rate for Payer: United Healthcare All Other HMO |
$40.99
|
| Rate for Payer: United Healthcare All Other HMO |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$17.10
|
| Rate for Payer: United Healthcare HMO Rider |
$40.10
|
| Rate for Payer: United Healthcare HMO Rider |
$16.73
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.33
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION [41144]
|
Facility
|
OP
|
$32.66
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$29.39 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Adventist Health Commercial |
$22.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cash Price |
$17.97
|
| Rate for Payer: Cash Price |
$25.74
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$25.74
|
| Rate for Payer: Cash Price |
$17.97
|
| Rate for Payer: Central Health Plan Commercial |
$37.44
|
| Rate for Payer: Central Health Plan Commercial |
$26.13
|
| Rate for Payer: Central Health Plan Commercial |
$89.76
|
| Rate for Payer: Central Health Plan Commercial |
$71.81
|
| Rate for Payer: Cigna of CA HMO |
$62.83
|
| Rate for Payer: Cigna of CA HMO |
$78.54
|
| Rate for Payer: Cigna of CA HMO |
$22.86
|
| Rate for Payer: Cigna of CA HMO |
$32.76
|
| Rate for Payer: Cigna of CA PPO |
$78.54
|
| Rate for Payer: Cigna of CA PPO |
$22.86
|
| Rate for Payer: Cigna of CA PPO |
$32.76
|
| Rate for Payer: Cigna of CA PPO |
$62.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: EPIC Health Plan Senior |
$18.72
|
| Rate for Payer: EPIC Health Plan Senior |
$35.90
|
| Rate for Payer: EPIC Health Plan Senior |
$44.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Galaxy Health WC |
$27.76
|
| Rate for Payer: Galaxy Health WC |
$95.37
|
| Rate for Payer: Galaxy Health WC |
$39.78
|
| Rate for Payer: Global Benefits Group Commercial |
$67.32
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Global Benefits Group Commercial |
$28.08
|
| Rate for Payer: Global Benefits Group Commercial |
$19.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.28
|
| Rate for Payer: InnovAge PACE Commercial |
$44.88
|
| Rate for Payer: InnovAge PACE Commercial |
$56.10
|
| Rate for Payer: InnovAge PACE Commercial |
$16.33
|
| Rate for Payer: InnovAge PACE Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.54
|
| Rate for Payer: Multiplan Commercial |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$84.15
|
| Rate for Payer: Multiplan Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$67.32
|
| Rate for Payer: Networks By Design Commercial |
$44.88
|
| Rate for Payer: Networks By Design Commercial |
$16.33
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Commercial |
$95.37
|
| Rate for Payer: Prime Health Services Commercial |
$27.76
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: Prime Health Services Commercial |
$39.78
|
| Rate for Payer: Riverside University Health System MISP |
$13.06
|
| Rate for Payer: Riverside University Health System MISP |
$44.88
|
| Rate for Payer: Riverside University Health System MISP |
$18.72
|
| Rate for Payer: Riverside University Health System MISP |
$35.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.56
|
| Rate for Payer: United Healthcare All Other HMO |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$17.10
|
| Rate for Payer: United Healthcare All Other HMO |
$40.99
|
| Rate for Payer: United Healthcare All Other HMO |
$11.93
|
| Rate for Payer: United Healthcare HMO Rider |
$16.73
|
| Rate for Payer: United Healthcare HMO Rider |
$40.10
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.37
|
| Rate for Payer: Vantage Medical Group Senior |
$27.76
|
| Rate for Payer: Vantage Medical Group Senior |
$76.30
|
| Rate for Payer: Vantage Medical Group Senior |
$39.78
|
| Rate for Payer: Vantage Medical Group Senior |
$95.37
|
|
|
MICAFUNGIN 50 MG INTRAVENOUS SOLUTION [41144]
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
HCPCS J2247
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Adventist Health Commercial |
$17.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Cash Price |
$49.37
|
| Rate for Payer: Central Health Plan Commercial |
$71.81
|
| Rate for Payer: Cigna of CA HMO |
$62.83
|
| Rate for Payer: Cigna of CA PPO |
$62.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.90
|
| Rate for Payer: EPIC Health Plan Senior |
$35.90
|
| Rate for Payer: Galaxy Health WC |
$76.30
|
| Rate for Payer: Global Benefits Group Commercial |
$53.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.31
|
| Rate for Payer: InnovAge PACE Commercial |
$44.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.83
|
| Rate for Payer: Multiplan Commercial |
$67.32
|
| Rate for Payer: Networks By Design Commercial |
$44.88
|
| Rate for Payer: Prime Health Services Commercial |
$76.30
|
| Rate for Payer: Riverside University Health System MISP |
$35.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.69
|
| Rate for Payer: United Healthcare All Other HMO |
$32.79
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.30
|
|
|
MICONAZOLE NITRATE 100 MG VAGINAL SUPPOSITORY [10603]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 61269-736-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: InnovAge PACE Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
MICONAZOLE NITRATE 100 MG VAGINAL SUPPOSITORY [10603]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 61269-736-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.12
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
MICONAZOLE NITRATE 200 MG-2 % (9 GRAM) VAGINAL KIT [24855]
|
Facility
|
IP
|
$11.75
|
|
|
Service Code
|
NDC 24385-606-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.92
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Central Health Plan Commercial |
$9.40
|
| Rate for Payer: Cigna of CA HMO |
$8.22
|
| Rate for Payer: Cigna of CA PPO |
$8.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$9.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.99
|
|
|
MICONAZOLE NITRATE 200 MG-2 % (9 GRAM) VAGINAL KIT [24855]
|
Facility
|
OP
|
$11.75
|
|
|
Service Code
|
NDC 24385-606-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.69
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Central Health Plan Commercial |
$9.40
|
| Rate for Payer: Cigna of CA HMO |
$8.22
|
| Rate for Payer: Cigna of CA PPO |
$8.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$9.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.57
|
| Rate for Payer: InnovAge PACE Commercial |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.22
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.99
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5.88
|
| Rate for Payer: United Healthcare HMO Rider |
$5.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.99
|
| Rate for Payer: Vantage Medical Group Senior |
$9.99
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY [111721]
|
Facility
|
OP
|
$19.10
|
|
|
Service Code
|
NDC 0472-1738-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.22
|
| Rate for Payer: Blue Shield of California Commercial |
$11.67
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: Central Health Plan Commercial |
$15.28
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: EPIC Health Plan Senior |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.23
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.19
|
| Rate for Payer: InnovAge PACE Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.37
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$16.23
|
| Rate for Payer: Riverside University Health System MISP |
$7.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.55
|
| Rate for Payer: United Healthcare All Other HMO |
$9.55
|
| Rate for Payer: United Healthcare HMO Rider |
$9.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.23
|
| Rate for Payer: Vantage Medical Group Senior |
$16.23
|
|
|
MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY [111721]
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 0472-1738-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$14.76
|
| Rate for Payer: Blue Shield of California EPN |
$9.63
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: Central Health Plan Commercial |
$15.28
|
| Rate for Payer: Cigna of CA HMO |
$13.37
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: EPIC Health Plan Senior |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.23
|
| Rate for Payer: Global Benefits Group Commercial |
$11.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$16.23
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 68001-481-47
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 0536-1375-75
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 68001-481-47
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| 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 |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| 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 Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0536-1375-75
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: InnovAge PACE Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Riverside University Health System MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 61269-735-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 61269-735-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| 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 |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: InnovAge PACE Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| 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 Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER [10599]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0316-0225-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| 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: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER [10599]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0316-0225-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| 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: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: InnovAge PACE Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 24385-590-29
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| 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: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.14
|
| 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 System 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 Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 51672-2035-6
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: InnovAge PACE Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 8770179251
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 51672-2035-6
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 8770179251
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: InnovAge PACE Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| 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 Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM [5040]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 24385-590-29
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| 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
|
|
