|
COMPOUNDING VEHICLE (ORA-SWEET SF) SUGAR-FREE NO.9 ORAL LIQUID [120588]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 395009416
|
| Hospital Charge Code |
NDG120588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
COMPOUNDING VEHICLE (ORA-SWEET SF) SUGAR-FREE NO.9 ORAL LIQUID [120588]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 574030216
|
| Hospital Charge Code |
NDG120588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
COMPOUNDING VEHICLE (ORA-SWEET SF) SUGAR-FREE NO.9 ORAL LIQUID [120588]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 395009416
|
| Hospital Charge Code |
NDG120588
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23 [222005]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 574030416
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23 [222005]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
NDC 3877907448
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23 [222005]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
NDC 3877907448
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: 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
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23 [222005]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 3172295901
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23 [222005]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 574030416
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23 [222005]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 3172295901
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23 [222005]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 395009016
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
COMPOUNDING VEHICLE SYRUP NO.23 [222005]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 395009016
|
| Hospital Charge Code |
NDG120589
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.03
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$9,406.07
|
|
|
Service Code
|
APR-DRG 0572
|
| Min. Negotiated Rate |
$7,893.20 |
| Max. Negotiated Rate |
$9,406.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,893.20
|
| Rate for Payer: IEHP medi-cal |
$9,406.07
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$6,310.76
|
|
|
Service Code
|
APR-DRG 0571
|
| Min. Negotiated Rate |
$5,295.74 |
| Max. Negotiated Rate |
$6,310.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,295.74
|
| Rate for Payer: IEHP medi-cal |
$6,310.76
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$22,893.84
|
|
|
Service Code
|
APR-DRG 0574
|
| Min. Negotiated Rate |
$19,211.62 |
| Max. Negotiated Rate |
$22,893.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,211.62
|
| Rate for Payer: IEHP medi-cal |
$22,893.84
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
IP
|
$13,852.17
|
|
|
Service Code
|
APR-DRG 0573
|
| Min. Negotiated Rate |
$11,624.20 |
| Max. Negotiated Rate |
$13,852.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,624.20
|
| Rate for Payer: IEHP medi-cal |
$13,852.17
|
|
|
Condylectomy, temporomandibular joint (separate procedure)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$6,445.20
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$6,445.20
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
OP
|
$8.05
|
|
|
Service Code
|
NDC 0046-1100-81
|
| Hospital Charge Code |
1710526
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.76
|
| Rate for Payer: BCBS Transplant Transplant |
$4.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.44
|
| Rate for Payer: Cigna of CA HMO |
$5.64
|
| Rate for Payer: Cigna of CA PPO |
$5.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$4.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.04
|
| Rate for Payer: IEHP medi-cal |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$6.04
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.83
|
| Rate for Payer: Riverside University Health MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.84
|
| Rate for Payer: Vantage Medical Group Senior |
$6.84
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET [9973]
|
Facility
IP
|
$8.05
|
|
|
Service Code
|
NDC 0046-1100-81
|
| Hospital Charge Code |
1710526
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Blue Shield of California Commercial |
$6.04
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.44
|
| Rate for Payer: Cigna of CA HMO |
$5.64
|
| Rate for Payer: Cigna of CA PPO |
$5.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$4.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$6.04
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.84
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
OP
|
$17.48
|
|
|
Service Code
|
NDC 0046-0872-21
|
| Hospital Charge Code |
1743781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$15.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.33
|
| Rate for Payer: BCBS Transplant Transplant |
$10.49
|
| Rate for Payer: Blue Shield of California Commercial |
$10.99
|
| Rate for Payer: Blue Shield of California EPN |
$8.55
|
| Rate for Payer: Cash Price |
$7.87
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| Rate for Payer: Cigna of CA HMO |
$12.24
|
| Rate for Payer: Cigna of CA PPO |
$12.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.11
|
| Rate for Payer: IEHP medi-cal |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$13.11
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.49
|
| Rate for Payer: Riverside University Health MISP |
$6.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Other HMO |
$8.74
|
| Rate for Payer: United Healthcare HMO Rider |
$8.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.86
|
| Rate for Payer: Vantage Medical Group Senior |
$14.86
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM [9977]
|
Facility
IP
|
$17.48
|
|
|
Service Code
|
NDC 0046-0872-21
|
| Hospital Charge Code |
1743781
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$15.73 |
| Rate for Payer: Blue Shield of California Commercial |
$13.11
|
| Rate for Payer: Blue Shield of California EPN |
$9.33
|
| Rate for Payer: Cash Price |
$7.87
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| Rate for Payer: Cigna of CA HMO |
$12.24
|
| Rate for Payer: Cigna of CA PPO |
$12.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$13.11
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.86
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
OP
|
$8.05
|
|
|
Service Code
|
NDC 0046-1102-81
|
| Hospital Charge Code |
1710519
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.76
|
| Rate for Payer: BCBS Transplant Transplant |
$4.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.44
|
| Rate for Payer: Cigna of CA HMO |
$5.64
|
| Rate for Payer: Cigna of CA PPO |
$5.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$4.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.04
|
| Rate for Payer: IEHP medi-cal |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$6.04
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.83
|
| Rate for Payer: Riverside University Health MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.84
|
| Rate for Payer: Vantage Medical Group Senior |
$6.84
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET [9974]
|
Facility
IP
|
$8.05
|
|
|
Service Code
|
NDC 0046-1102-81
|
| Hospital Charge Code |
1710519
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Blue Shield of California Commercial |
$6.04
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.44
|
| Rate for Payer: Cigna of CA HMO |
$5.64
|
| Rate for Payer: Cigna of CA PPO |
$5.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.84
|
| Rate for Payer: Global Benefits Group Commercial |
$4.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$6.04
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.84
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION [9972]
|
Facility
IP
|
$428.80
|
|
|
Service Code
|
CPT J1410
|
| Hospital Charge Code |
1720160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.76 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Blue Shield of California Commercial |
$321.60
|
| Rate for Payer: Blue Shield of California EPN |
$228.98
|
| Rate for Payer: Cash Price |
$192.96
|
| Rate for Payer: Central Health Plan Commercial |
$343.04
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$300.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.52
|
| Rate for Payer: Galaxy Health WC |
$364.48
|
| Rate for Payer: Global Benefits Group Commercial |
$257.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.76
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Networks By Design Commercial |
$214.40
|
| Rate for Payer: Prime Health Services Commercial |
$364.48
|
|
