|
PROCHLORPERAZINE EDISYLATE 5 MG/ML INJECTION SOLUTION [6580]
|
Facility
OP
|
$2.79
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
NDG6580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.57
|
| Rate for Payer: BCBS Transplant Transplant |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$22.10
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.23
|
| Rate for Payer: Cigna of CA HMO |
$1.95
|
| Rate for Payer: Cigna of CA PPO |
$1.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.09
|
| Rate for Payer: IEHP medi-cal |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Networks By Design Commercial |
$1.40
|
| Rate for Payer: Prime Health Services Commercial |
$2.37
|
| Rate for Payer: Riverside University Health MISP |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
IP
|
$0.63
|
|
|
Service Code
|
NDC 59746-115-06
|
| Hospital Charge Code |
1710783
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
OP
|
$1.77
|
|
|
Service Code
|
NDC 50268-685-11
|
| Hospital Charge Code |
1710783
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: BCBS Transplant Transplant |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.24
|
| Rate for Payer: Cigna of CA PPO |
$1.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.33
|
| Rate for Payer: IEHP medi-cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.15
|
| Rate for Payer: Prime Health Services Commercial |
$1.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.06
|
| Rate for Payer: Riverside University Health MISP |
$0.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1.50
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
IP
|
$1.77
|
|
|
Service Code
|
NDC 50268-685-11
|
| Hospital Charge Code |
1710783
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.24
|
| Rate for Payer: Cigna of CA PPO |
$1.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.15
|
| Rate for Payer: Prime Health Services Commercial |
$1.50
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
OP
|
$0.63
|
|
|
Service Code
|
NDC 59746-115-06
|
| Hospital Charge Code |
1710783
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: BCBS Transplant Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.44
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.47
|
| Rate for Payer: IEHP medi-cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: Riverside University Health MISP |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]
|
Facility
IP
|
$0.42
|
|
|
Service Code
|
NDC 59746-113-06
|
| Hospital Charge Code |
1710782
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET [6583]
|
Facility
OP
|
$0.42
|
|
|
Service Code
|
NDC 59746-113-06
|
| Hospital Charge Code |
1710782
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.32
|
| Rate for Payer: IEHP medi-cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: Riverside University Health MISP |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
PROGESTERONE 50 MG/ML INTRAMUSCULAR OIL [6597]
|
Facility
OP
|
$3.59
|
|
|
Service Code
|
CPT J2675
|
| Hospital Charge Code |
1721037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.02
|
| Rate for Payer: BCBS Transplant Transplant |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.76
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.69
|
| Rate for Payer: IEHP medi-cal |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
| Rate for Payer: Riverside University Health MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
PROGESTERONE 50 MG/ML INTRAMUSCULAR OIL [6597]
|
Facility
IP
|
$3.59
|
|
|
Service Code
|
CPT J2675
|
| Hospital Charge Code |
1721037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.05
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
NDC 59651-152-01
|
| Hospital Charge Code |
1711912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.18
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
NDC 43598-349-01
|
| Hospital Charge Code |
1711912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: BCBS Transplant Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.98
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: Riverside University Health MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
NDC 43598-349-01
|
| Hospital Charge Code |
1711912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 17478-766-10
|
| Hospital Charge Code |
1711912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: IEHP medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Riverside University Health MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
IP
|
$0.24
|
|
|
Service Code
|
NDC 59651-152-01
|
| Hospital Charge Code |
1711912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE [23122]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 17478-766-10
|
| Hospital Charge Code |
1711912
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
IP
|
$11.70
|
|
|
Service Code
|
NDC 51672-5296-1
|
| Hospital Charge Code |
1748042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Blue Shield of California Commercial |
$8.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.25
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.94
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
IP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0536-06
|
| Hospital Charge Code |
1748042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Blue Shield of California Commercial |
$8.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.25
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.94
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
OP
|
$11.70
|
|
|
Service Code
|
NDC 51672-5296-1
|
| Hospital Charge Code |
1748042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: BCBS Transplant Transplant |
$7.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7.36
|
| Rate for Payer: Blue Shield of California EPN |
$5.72
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.78
|
| Rate for Payer: IEHP medi-cal |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: Riverside University Health MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.94
|
| Rate for Payer: Vantage Medical Group Senior |
$9.94
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
OP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0536-12
|
| Hospital Charge Code |
1748042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: BCBS Transplant Transplant |
$7.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7.36
|
| Rate for Payer: Blue Shield of California EPN |
$5.72
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.78
|
| Rate for Payer: IEHP medi-cal |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: Riverside University Health MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.94
|
| Rate for Payer: Vantage Medical Group Senior |
$9.94
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
IP
|
$11.70
|
|
|
Service Code
|
NDC 51672-5296-5
|
| Hospital Charge Code |
1748042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Blue Shield of California Commercial |
$8.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.25
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.94
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
OP
|
$11.70
|
|
|
Service Code
|
NDC 51672-5296-5
|
| Hospital Charge Code |
1748042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: BCBS Transplant Transplant |
$7.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7.36
|
| Rate for Payer: Blue Shield of California EPN |
$5.72
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.78
|
| Rate for Payer: IEHP medi-cal |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: Riverside University Health MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.94
|
| Rate for Payer: Vantage Medical Group Senior |
$9.94
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
OP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0536-06
|
| Hospital Charge Code |
1748042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: BCBS Transplant Transplant |
$7.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7.36
|
| Rate for Payer: Blue Shield of California EPN |
$5.72
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.78
|
| Rate for Payer: IEHP medi-cal |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: Riverside University Health MISP |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.94
|
| Rate for Payer: Vantage Medical Group Senior |
$9.94
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY [11143]
|
Facility
IP
|
$11.70
|
|
|
Service Code
|
NDC 0713-0536-12
|
| Hospital Charge Code |
1748042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Blue Shield of California Commercial |
$8.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.25
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$9.36
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.68
|
| Rate for Payer: Galaxy Health WC |
$9.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$8.78
|
| Rate for Payer: Networks By Design Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.94
|
|
|
PROMETHAZINE 12.5 MG TABLET [6621]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 68001-161-00
|
| Hospital Charge Code |
1710621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| 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 |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
PROMETHAZINE 12.5 MG TABLET [6621]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 68001-161-00
|
| Hospital Charge Code |
1710621
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
