|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
|
OP
|
$19.20
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Adventist Health Commercial |
$9.48
|
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.80
|
| Rate for Payer: Blue Shield of California Commercial |
$12.87
|
| Rate for Payer: Blue Shield of California Commercial |
$12.87
|
| Rate for Payer: Blue Shield of California Commercial |
$12.87
|
| Rate for Payer: Blue Shield of California Commercial |
$12.87
|
| Rate for Payer: Blue Shield of California EPN |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$11.70
|
| Rate for Payer: Blue Shield of California EPN |
$11.70
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$30.86
|
| Rate for Payer: Central Health Plan Commercial |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$37.92
|
| Rate for Payer: Central Health Plan Commercial |
$15.36
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA HMO |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$33.18
|
| Rate for Payer: Cigna of CA PPO |
$44.10
|
| Rate for Payer: Cigna of CA PPO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$33.18
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: EPIC Health Plan Senior |
$3.89
|
| Rate for Payer: Galaxy Health WC |
$40.29
|
| Rate for Payer: Galaxy Health WC |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Galaxy Health WC |
$32.78
|
| Rate for Payer: Global Benefits Group Commercial |
$23.14
|
| Rate for Payer: Global Benefits Group Commercial |
$28.44
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.89
|
| Rate for Payer: InnovAge PACE Commercial |
$5.84
|
| Rate for Payer: InnovAge PACE Commercial |
$5.84
|
| Rate for Payer: InnovAge PACE Commercial |
$5.84
|
| Rate for Payer: InnovAge PACE Commercial |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$28.93
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$35.55
|
| Rate for Payer: Networks By Design Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$19.29
|
| Rate for Payer: Networks By Design Commercial |
$23.70
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$40.29
|
| Rate for Payer: Prime Health Services Commercial |
$16.32
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Prime Health Services Commercial |
$32.78
|
| Rate for Payer: Prime Health Services Medicare |
$4.13
|
| Rate for Payer: Prime Health Services Medicare |
$4.13
|
| Rate for Payer: Prime Health Services Medicare |
$4.13
|
| Rate for Payer: Prime Health Services Medicare |
$4.13
|
| Rate for Payer: Riverside University Health System MISP |
$4.28
|
| Rate for Payer: Riverside University Health System MISP |
$4.28
|
| Rate for Payer: Riverside University Health System MISP |
$4.28
|
| Rate for Payer: Riverside University Health System MISP |
$4.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.32
|
| Rate for Payer: United Healthcare All Other HMO |
$14.09
|
| Rate for Payer: United Healthcare All Other HMO |
$23.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$16.94
|
| Rate for Payer: United Healthcare HMO Rider |
$22.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.78
|
| Rate for Payer: United Healthcare HMO Rider |
$6.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
|
IP
|
$38.57
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$34.71 |
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Adventist Health Commercial |
$9.48
|
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California Commercial |
$29.81
|
| Rate for Payer: Blue Shield of California Commercial |
$14.84
|
| Rate for Payer: Blue Shield of California Commercial |
$48.70
|
| Rate for Payer: Blue Shield of California Commercial |
$36.64
|
| Rate for Payer: Blue Shield of California EPN |
$19.44
|
| Rate for Payer: Blue Shield of California EPN |
$9.68
|
| Rate for Payer: Blue Shield of California EPN |
$23.89
|
| Rate for Payer: Blue Shield of California EPN |
$31.75
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Central Health Plan Commercial |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$30.86
|
| Rate for Payer: Central Health Plan Commercial |
$15.36
|
| Rate for Payer: Central Health Plan Commercial |
$37.92
|
| Rate for Payer: Cigna of CA HMO |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$33.18
|
| Rate for Payer: Cigna of CA HMO |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: Cigna of CA PPO |
$33.18
|
| Rate for Payer: Cigna of CA PPO |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Senior |
$15.43
|
| Rate for Payer: EPIC Health Plan Senior |
$25.20
|
| Rate for Payer: EPIC Health Plan Senior |
$18.96
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$32.78
|
| Rate for Payer: Galaxy Health WC |
$40.29
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Galaxy Health WC |
$16.32
|
| Rate for Payer: Global Benefits Group Commercial |
$28.44
|
| Rate for Payer: Global Benefits Group Commercial |
$11.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.14
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.48
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$28.93
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$35.55
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$23.70
|
| Rate for Payer: Networks By Design Commercial |
$19.29
|
| Rate for Payer: Prime Health Services Commercial |
$40.29
|
| Rate for Payer: Prime Health Services Commercial |
$32.78
|
| Rate for Payer: Prime Health Services Commercial |
$16.32
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.48
|
| Rate for Payer: United Healthcare All Other HMO |
$14.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$23.01
|
| Rate for Payer: United Healthcare All Other HMO |
$17.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.94
|
| Rate for Payer: United Healthcare HMO Rider |
$22.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.52
|
|
|
DESMOPRESSIN ORAL SOLUTION COMPOUND 10 MCG/ML [4080400]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 9994-0804-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
DESMOPRESSIN ORAL SOLUTION COMPOUND 10 MCG/ML [4080400]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 9994-0804-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: InnovAge PACE Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
NDC 51672-1281-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.67
|
| Rate for Payer: InnovAge PACE Commercial |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
| Rate for Payer: Riverside University Health System MISP |
$0.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.57
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
NDC 51672-1281-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.67
|
| Rate for Payer: InnovAge PACE Commercial |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
| Rate for Payer: Riverside University Health System MISP |
$0.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.57
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
NDC 51672-1281-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
NDC 51672-1281-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.39
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
|
|
DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
NDC 45802-495-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$2.63
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.96
|
| Rate for Payer: InnovAge PACE Commercial |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$2.47
|
| Rate for Payer: Networks By Design Commercial |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
| Rate for Payer: Riverside University Health System MISP |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2.80
|
|
|
DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
NDC 45802-495-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$2.63
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.47
|
| Rate for Payer: Networks By Design Commercial |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [205849]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
NDC 51991-006-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.05
|
| Rate for Payer: InnovAge PACE Commercial |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Riverside University Health System MISP |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
DESVENLAFAXINE SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR [205849]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
NDC 51991-006-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.82
|
| Rate for Payer: Cigna of CA PPO |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$17.52
|
|
|
Service Code
|
NDC 0008-1211-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$13.54
|
| Rate for Payer: Blue Shield of California EPN |
$8.83
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Senior |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$17.52
|
|
|
Service Code
|
NDC 0008-1211-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.29
|
| Rate for Payer: Blue Shield of California Commercial |
$10.70
|
| Rate for Payer: Blue Shield of California EPN |
$6.99
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Senior |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.77
|
| Rate for Payer: InnovAge PACE Commercial |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.26
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Riverside University Health System MISP |
$7.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.89
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$17.52
|
|
|
Service Code
|
NDC 0008-1211-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.29
|
| Rate for Payer: Blue Shield of California Commercial |
$10.70
|
| Rate for Payer: Blue Shield of California EPN |
$6.99
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Senior |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.77
|
| Rate for Payer: InnovAge PACE Commercial |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.26
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
| Rate for Payer: Riverside University Health System MISP |
$7.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.89
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
NDC 0054-0400-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$0.89
|
| Rate for Payer: Cigna of CA PPO |
$0.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.14
|
| Rate for Payer: InnovAge PACE Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1.08
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
NDC 0054-0400-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$0.89
|
| Rate for Payer: Cigna of CA PPO |
$0.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.14
|
| Rate for Payer: InnovAge PACE Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1.08
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
NDC 0054-0400-22
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$0.89
|
| Rate for Payer: Cigna of CA PPO |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.08
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 59762-1211-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: InnovAge PACE Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Riverside University Health System MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$17.52
|
|
|
Service Code
|
NDC 0008-1211-14
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$13.54
|
| Rate for Payer: Blue Shield of California EPN |
$8.83
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$12.26
|
| Rate for Payer: Cigna of CA PPO |
$12.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Senior |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.89
|
| Rate for Payer: Global Benefits Group Commercial |
$10.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.89
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
NDC 0054-0400-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$0.89
|
| Rate for Payer: Cigna of CA PPO |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: EPIC Health Plan Senior |
$0.51
|
| Rate for Payer: Galaxy Health WC |
$1.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.08
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [91073]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 59762-1211-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
DEXAMETH 1 MG-MOXIFLOX 0.5 MG-KETOROLAC 0.4 MG/ML(PF) INTRAOCULAR SOLN [221697]
|
Facility
|
OP
|
$38.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.55
|
| Rate for Payer: Blue Shield of California Commercial |
$23.46
|
| Rate for Payer: Blue Shield of California EPN |
$15.32
|
| Rate for Payer: Cash Price |
$21.12
|
| Rate for Payer: Central Health Plan Commercial |
$30.72
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$26.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Senior |
$15.36
|
| Rate for Payer: Galaxy Health WC |
$32.64
|
| Rate for Payer: Global Benefits Group Commercial |
$23.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.56
|
| Rate for Payer: InnovAge PACE Commercial |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$19.20
|
| Rate for Payer: Prime Health Services Commercial |
$32.64
|
| Rate for Payer: Riverside University Health System MISP |
$15.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO |
$14.03
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Vantage Medical Group Senior |
$32.64
|
|
|
DEXAMETH 1 MG-MOXIFLOX 0.5 MG-KETOROLAC 0.4 MG/ML(PF) INTRAOCULAR SOLN [221697]
|
Facility
|
IP
|
$38.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$29.68
|
| Rate for Payer: Blue Shield of California EPN |
$19.35
|
| Rate for Payer: Cash Price |
$21.12
|
| Rate for Payer: Central Health Plan Commercial |
$30.72
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$26.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Senior |
$15.36
|
| Rate for Payer: Galaxy Health WC |
$32.64
|
| Rate for Payer: Global Benefits Group Commercial |
$23.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$19.20
|
| Rate for Payer: Prime Health Services Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO |
$14.03
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.58
|
|
|
DEXAMETHASONE 0.1% EYE DROPS. [4082335]
|
Facility
|
OP
|
$12.94
|
|
|
Service Code
|
NDC 24208-720-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7.91
|
| Rate for Payer: Blue Shield of California EPN |
$5.16
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Central Health Plan Commercial |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.65
|
| Rate for Payer: InnovAge PACE Commercial |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: Networks By Design Commercial |
$8.41
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Riverside University Health System MISP |
$5.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.00
|
|
