|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208667]
|
Facility
IP
|
$6.03
|
|
|
Service Code
|
NDC 59011-410-20
|
| Hospital Charge Code |
1730114
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.52
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Central Health Plan Commercial |
$4.82
|
| Rate for Payer: Cigna of CA HMO |
$4.22
|
| Rate for Payer: Cigna of CA PPO |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.52
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208667]
|
Facility
OP
|
$6.03
|
|
|
Service Code
|
NDC 59011-410-20
|
| Hospital Charge Code |
1730114
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.56
|
| Rate for Payer: BCBS Transplant Transplant |
$3.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3.79
|
| Rate for Payer: Blue Shield of California EPN |
$2.95
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Central Health Plan Commercial |
$4.82
|
| Rate for Payer: Cigna of CA HMO |
$4.22
|
| Rate for Payer: Cigna of CA PPO |
$4.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.52
|
| Rate for Payer: IEHP medi-cal |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.52
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: Riverside University Health MISP |
$2.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
NDC 69238-2296-1
|
| Hospital Charge Code |
1730115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.32
|
| Rate for Payer: BCBS Transplant Transplant |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5.66
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.75
|
| Rate for Payer: IEHP medi-cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: Riverside University Health MISP |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
NDC 69238-2296-1
|
| Hospital Charge Code |
1730115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]
|
Facility
IP
|
$11.23
|
|
|
Service Code
|
NDC 59011-420-20
|
| Hospital Charge Code |
1730115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8.42
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208669]
|
Facility
OP
|
$11.23
|
|
|
Service Code
|
NDC 59011-420-20
|
| Hospital Charge Code |
1730115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: BCBS Transplant Transplant |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$7.06
|
| Rate for Payer: Blue Shield of California EPN |
$5.49
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$7.86
|
| Rate for Payer: Cigna of CA PPO |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.42
|
| Rate for Payer: IEHP medi-cal |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: Riverside University Health MISP |
$4.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO |
$5.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208671]
|
Facility
OP
|
$19.22
|
|
|
Service Code
|
NDC 59011-440-20
|
| Hospital Charge Code |
1731015
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.36
|
| Rate for Payer: BCBS Transplant Transplant |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$12.09
|
| Rate for Payer: Blue Shield of California EPN |
$9.40
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Central Health Plan Commercial |
$15.38
|
| Rate for Payer: Cigna of CA HMO |
$13.45
|
| Rate for Payer: Cigna of CA PPO |
$13.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.69
|
| Rate for Payer: Galaxy Health WC |
$16.34
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.42
|
| Rate for Payer: IEHP medi-cal |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$14.42
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: Prime Health Services Commercial |
$16.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.53
|
| Rate for Payer: Riverside University Health MISP |
$7.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.61
|
| Rate for Payer: United Healthcare All Other HMO |
$9.61
|
| Rate for Payer: United Healthcare HMO Rider |
$9.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.34
|
| Rate for Payer: Vantage Medical Group Senior |
$16.34
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208671]
|
Facility
IP
|
$19.22
|
|
|
Service Code
|
NDC 59011-440-20
|
| Hospital Charge Code |
1731015
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.42
|
| Rate for Payer: Blue Shield of California EPN |
$10.26
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Central Health Plan Commercial |
$15.38
|
| Rate for Payer: Cigna of CA HMO |
$13.45
|
| Rate for Payer: Cigna of CA PPO |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.69
|
| Rate for Payer: Galaxy Health WC |
$16.34
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$14.42
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: Prime Health Services Commercial |
$16.34
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208673]
|
Facility
IP
|
$33.56
|
|
|
Service Code
|
NDC 59011-480-20
|
| Hospital Charge Code |
1731012
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$25.17
|
| Rate for Payer: Blue Shield of California EPN |
$17.92
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Central Health Plan Commercial |
$26.85
|
| Rate for Payer: Cigna of CA HMO |
$23.49
|
| Rate for Payer: Cigna of CA PPO |
$23.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.42
|
| Rate for Payer: Galaxy Health WC |
$28.53
|
| Rate for Payer: Global Benefits Group Commercial |
$20.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$25.17
|
| Rate for Payer: Networks By Design Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$28.53
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [208673]
|
Facility
OP
|
$33.56
|
|
|
Service Code
|
NDC 59011-480-20
|
| Hospital Charge Code |
1731012
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.83
|
| Rate for Payer: BCBS Transplant Transplant |
$20.14
|
| Rate for Payer: Blue Shield of California Commercial |
$21.11
|
| Rate for Payer: Blue Shield of California EPN |
$16.41
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Central Health Plan Commercial |
$26.85
|
| Rate for Payer: Cigna of CA HMO |
$23.49
|
| Rate for Payer: Cigna of CA PPO |
$23.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.42
|
| Rate for Payer: Galaxy Health WC |
$28.53
|
| Rate for Payer: Global Benefits Group Commercial |
$20.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.17
|
| Rate for Payer: IEHP medi-cal |
$11.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$25.17
|
| Rate for Payer: Networks By Design Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$28.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$20.14
|
| Rate for Payer: Riverside University Health MISP |
$13.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.78
|
| Rate for Payer: United Healthcare All Other HMO |
$16.78
|
| Rate for Payer: United Healthcare HMO Rider |
$16.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.53
|
| Rate for Payer: Vantage Medical Group Senior |
$28.53
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
IP
|
$0.45
|
|
|
Service Code
|
NDC 11523-1159-1
|
| Hospital Charge Code |
NDG114934
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 2390002326
|
| Hospital Charge Code |
NDG114934
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
OP
|
$0.45
|
|
|
Service Code
|
NDC 11523-1159-1
|
| Hospital Charge Code |
NDG114934
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: BCBS Transplant Transplant |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.34
|
| Rate for Payer: IEHP medi-cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: Riverside University Health MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 2390002325
|
| Hospital Charge Code |
NDG114934
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
OP
|
$0.53
|
|
|
Service Code
|
NDC 0363-0308-01
|
| Hospital Charge Code |
NDG114934
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: BCBS Transplant Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.40
|
| Rate for Payer: IEHP medi-cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: Riverside University Health MISP |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 2390002325
|
| Hospital Charge Code |
NDG114934
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Riverside University Health MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
IP
|
$0.53
|
|
|
Service Code
|
NDC 0363-0308-01
|
| Hospital Charge Code |
NDG114934
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST [114934]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 2390002326
|
| Hospital Charge Code |
NDG114934
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: Riverside University Health MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
OP
|
$0.40
|
|
|
Service Code
|
NDC 2390001252
|
| Hospital Charge Code |
1740011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: BCBS Transplant Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.30
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 8770189900
|
| Hospital Charge Code |
1740040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| 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
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 49035-304-10
|
| Hospital Charge Code |
1740040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| 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 |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
OP
|
$0.32
|
|
|
Service Code
|
NDC 5002443100
|
| Hospital Charge Code |
1740011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.24
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: Riverside University Health MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
IP
|
$0.40
|
|
|
Service Code
|
NDC 37000-803-01
|
| Hospital Charge Code |
1740011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 49035-304-10
|
| Hospital Charge Code |
1740040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 0904-6761-30
|
| Hospital Charge Code |
1740040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| 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: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
