|
SALIVA STIMULANT COMBINATION NO.7 ORAL MUCOSAL GEL [216603]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 4858251201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
SARGRAMOSTIM 250 MCG SOLUTION FOR INJECTION [11338]
|
Facility
|
OP
|
$377.55
|
|
|
Service Code
|
HCPCS J2820
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.47 |
| Max. Negotiated Rate |
$371.09 |
| Rate for Payer: Adventist Health Commercial |
$75.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$371.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.87
|
| Rate for Payer: Blue Shield of California Commercial |
$81.43
|
| Rate for Payer: Blue Shield of California EPN |
$74.03
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Central Health Plan Commercial |
$302.04
|
| Rate for Payer: Cigna of CA HMO |
$264.29
|
| Rate for Payer: Cigna of CA PPO |
$264.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.08
|
| Rate for Payer: EPIC Health Plan Senior |
$68.72
|
| Rate for Payer: Galaxy Health WC |
$320.92
|
| Rate for Payer: Global Benefits Group Commercial |
$226.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$102.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.71
|
| Rate for Payer: Multiplan Commercial |
$283.16
|
| Rate for Payer: Networks By Design Commercial |
$188.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.47
|
| Rate for Payer: Prime Health Services Commercial |
$320.92
|
| Rate for Payer: Prime Health Services Medicare |
$66.22
|
| Rate for Payer: Riverside University Health System MISP |
$68.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.69
|
| Rate for Payer: United Healthcare All Other HMO |
$137.92
|
| Rate for Payer: United Healthcare HMO Rider |
$134.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Vantage Medical Group Senior |
$68.72
|
|
|
SARGRAMOSTIM 250 MCG SOLUTION FOR INJECTION [11338]
|
Facility
|
IP
|
$377.55
|
|
|
Service Code
|
HCPCS J2820
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.51 |
| Max. Negotiated Rate |
$339.80 |
| Rate for Payer: Adventist Health Commercial |
$75.51
|
| Rate for Payer: Blue Shield of California Commercial |
$302.80
|
| Rate for Payer: Blue Shield of California EPN |
$190.29
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Central Health Plan Commercial |
$302.04
|
| Rate for Payer: Cigna of CA HMO |
$264.29
|
| Rate for Payer: Cigna of CA PPO |
$264.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.02
|
| Rate for Payer: EPIC Health Plan Senior |
$151.02
|
| Rate for Payer: Galaxy Health WC |
$320.92
|
| Rate for Payer: Global Benefits Group Commercial |
$226.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.51
|
| Rate for Payer: Multiplan Commercial |
$283.16
|
| Rate for Payer: Networks By Design Commercial |
$188.78
|
| Rate for Payer: Prime Health Services Commercial |
$320.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.69
|
| Rate for Payer: United Healthcare All Other HMO |
$137.92
|
| Rate for Payer: United Healthcare HMO Rider |
$134.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.65
|
|
|
SARILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE [216968]
|
Facility
|
IP
|
$2,568.38
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$513.68 |
| Max. Negotiated Rate |
$2,311.54 |
| Rate for Payer: Adventist Health Commercial |
$513.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,059.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,294.46
|
| Rate for Payer: Cash Price |
$1,155.77
|
| Rate for Payer: Central Health Plan Commercial |
$2,054.70
|
| Rate for Payer: Cigna of CA HMO |
$1,797.87
|
| Rate for Payer: Cigna of CA PPO |
$1,797.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,797.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,027.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,027.35
|
| Rate for Payer: Galaxy Health WC |
$2,183.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1,541.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,311.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,515.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.68
|
| Rate for Payer: Multiplan Commercial |
$1,926.29
|
| Rate for Payer: Networks By Design Commercial |
$1,284.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,183.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$963.91
|
| Rate for Payer: United Healthcare All Other HMO |
$938.23
|
| Rate for Payer: United Healthcare HMO Rider |
$917.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$841.14
|
|
|
SARILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE [216968]
|
Facility
|
OP
|
$2,568.38
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$513.68 |
| Max. Negotiated Rate |
$2,311.54 |
| Rate for Payer: Adventist Health Commercial |
$513.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,559.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,183.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,412.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,926.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,243.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,494.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,628.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,024.78
|
| Rate for Payer: Cash Price |
$1,155.77
|
| Rate for Payer: Central Health Plan Commercial |
$2,054.70
|
| Rate for Payer: Cigna of CA HMO |
$1,797.87
|
| Rate for Payer: Cigna of CA PPO |
$1,797.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,183.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,183.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,183.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,797.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,027.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,027.35
|
| Rate for Payer: Galaxy Health WC |
$2,183.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1,541.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,311.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,630.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$932.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,515.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,797.87
|
| Rate for Payer: Multiplan Commercial |
$1,926.29
|
| Rate for Payer: Networks By Design Commercial |
$1,284.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,183.12
|
| Rate for Payer: Riverside University Health System MISP |
$1,027.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,541.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,541.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$963.91
|
| Rate for Payer: United Healthcare All Other HMO |
$938.23
|
| Rate for Payer: United Healthcare HMO Rider |
$917.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$841.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,183.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,183.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,183.12
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$18,304.96
|
|
|
Service Code
|
APR-DRG 7613
|
| Min. Negotiated Rate |
$11,561.03 |
| Max. Negotiated Rate |
$18,304.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,561.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,776.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,304.96
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$36,809.33
|
|
|
Service Code
|
APR-DRG 7614
|
| Min. Negotiated Rate |
$23,248.00 |
| Max. Negotiated Rate |
$36,809.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,248.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,703.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,809.33
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$9,887.66
|
|
|
Service Code
|
APR-DRG 7611
|
| Min. Negotiated Rate |
$6,244.84 |
| Max. Negotiated Rate |
$9,887.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,244.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,441.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,887.66
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$10,203.89
|
|
|
Service Code
|
APR-DRG 7612
|
| Min. Negotiated Rate |
$6,444.56 |
| Max. Negotiated Rate |
$10,203.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,444.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,679.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,203.89
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$10,735.63
|
|
|
Service Code
|
APR-DRG 7502
|
| Min. Negotiated Rate |
$6,780.40 |
| Max. Negotiated Rate |
$10,735.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,780.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,079.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,735.63
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$33,775.96
|
|
|
Service Code
|
APR-DRG 7504
|
| Min. Negotiated Rate |
$21,332.18 |
| Max. Negotiated Rate |
$33,775.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,332.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,420.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,775.96
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$16,043.03
|
|
|
Service Code
|
APR-DRG 7503
|
| Min. Negotiated Rate |
$10,132.44 |
| Max. Negotiated Rate |
$16,043.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,132.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,074.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,043.03
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$8,276.31
|
|
|
Service Code
|
APR-DRG 7501
|
| Min. Negotiated Rate |
$5,227.14 |
| Max. Negotiated Rate |
$8,276.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,227.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,229.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,276.31
|
|
|
SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 67255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$307.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,316.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,316.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$8,144.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,847.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,316.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,771.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5,847.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,718.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,442.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,123.80
|
| Rate for Payer: Multiplan WC |
$8,144.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Preferred Health Network WC |
$8,310.38
|
| Rate for Payer: Prime Health Services Medicare |
$5,635.25
|
| Rate for Payer: Prime Health Services WC |
$8,061.07
|
| Rate for Payer: Riverside University Health System MISP |
$5,847.90
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,316.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,316.27
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$22.06
|
|
|
Service Code
|
NDC 0378647016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.83
|
| Rate for Payer: Blue Shield of California Commercial |
$13.99
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$15.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$19.39
|
|
|
Service Code
|
NDC 0378647099
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.28
|
| Rate for Payer: Blue Shield of California Commercial |
$12.29
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Central Health Plan Commercial |
$15.51
|
| Rate for Payer: Cigna of CA HMO |
$13.57
|
| Rate for Payer: Cigna of CA PPO |
$13.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.76
|
| Rate for Payer: EPIC Health Plan Senior |
$7.76
|
| Rate for Payer: Galaxy Health WC |
$16.48
|
| Rate for Payer: Global Benefits Group Commercial |
$11.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.57
|
| Rate for Payer: Multiplan Commercial |
$14.54
|
| Rate for Payer: Networks By Design Commercial |
$12.60
|
| Rate for Payer: Prime Health Services Commercial |
$16.48
|
| Rate for Payer: Riverside University Health System MISP |
$7.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.48
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 4580258001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.55
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Riverside University Health System MISP |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$19.39
|
|
|
Service Code
|
NDC 0378647099
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Blue Shield of California Commercial |
$15.55
|
| Rate for Payer: Blue Shield of California EPN |
$9.77
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Central Health Plan Commercial |
$15.51
|
| Rate for Payer: Cigna of CA HMO |
$13.57
|
| Rate for Payer: Cigna of CA PPO |
$13.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.76
|
| Rate for Payer: EPIC Health Plan Senior |
$7.76
|
| Rate for Payer: Galaxy Health WC |
$16.48
|
| Rate for Payer: Global Benefits Group Commercial |
$11.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Multiplan Commercial |
$14.54
|
| Rate for Payer: Networks By Design Commercial |
$12.60
|
| Rate for Payer: Prime Health Services Commercial |
$16.48
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$22.06
|
|
|
Service Code
|
NDC 0378647097
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.83
|
| Rate for Payer: Blue Shield of California Commercial |
$13.99
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$15.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 4580258084
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.55
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Riverside University Health System MISP |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
NDC 4580258001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California Commercial |
$9.14
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$7.98
|
| Rate for Payer: Cigna of CA PPO |
$7.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
OP
|
$8.54
|
|
|
Service Code
|
NDC 6923816621
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.97
|
| Rate for Payer: Blue Shield of California Commercial |
$5.41
|
| Rate for Payer: Blue Shield of California EPN |
$3.41
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$6.83
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$5.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$6.41
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$7.26
|
| Rate for Payer: Riverside University Health System MISP |
$3.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO |
$4.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Vantage Medical Group Senior |
$7.26
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$8.54
|
|
|
Service Code
|
NDC 6923816621
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6.85
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$6.83
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Senior |
$3.42
|
| Rate for Payer: Galaxy Health WC |
$7.26
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$6.41
|
| Rate for Payer: Networks By Design Commercial |
$5.55
|
| Rate for Payer: Prime Health Services Commercial |
$7.26
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$22.06
|
|
|
Service Code
|
NDC 0378647016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$15.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [27696]
|
Facility
|
IP
|
$22.06
|
|
|
Service Code
|
NDC 0378647097
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$15.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
