|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]
|
Facility
|
IP
|
$74.92
|
|
|
Service Code
|
NDC 5041949104
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$67.43 |
| Rate for Payer: Adventist Health Commercial |
$14.98
|
| Rate for Payer: Blue Shield of California Commercial |
$60.09
|
| Rate for Payer: Blue Shield of California EPN |
$37.76
|
| Rate for Payer: Cash Price |
$33.71
|
| Rate for Payer: Central Health Plan Commercial |
$59.94
|
| Rate for Payer: Cigna of CA HMO |
$52.44
|
| Rate for Payer: Cigna of CA PPO |
$52.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.97
|
| Rate for Payer: EPIC Health Plan Senior |
$29.97
|
| Rate for Payer: Galaxy Health WC |
$63.68
|
| Rate for Payer: Global Benefits Group Commercial |
$44.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.98
|
| Rate for Payer: Multiplan Commercial |
$56.19
|
| Rate for Payer: Networks By Design Commercial |
$48.70
|
| Rate for Payer: Prime Health Services Commercial |
$63.68
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]
|
Facility
|
OP
|
$74.92
|
|
|
Service Code
|
NDC 5041949104
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$67.43 |
| Rate for Payer: Adventist Health Commercial |
$14.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.58
|
| Rate for Payer: Blue Shield of California Commercial |
$47.50
|
| Rate for Payer: Blue Shield of California EPN |
$29.89
|
| Rate for Payer: Cash Price |
$33.71
|
| Rate for Payer: Central Health Plan Commercial |
$59.94
|
| Rate for Payer: Cigna of CA HMO |
$52.44
|
| Rate for Payer: Cigna of CA PPO |
$52.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.97
|
| Rate for Payer: EPIC Health Plan Senior |
$29.97
|
| Rate for Payer: Galaxy Health WC |
$63.68
|
| Rate for Payer: Global Benefits Group Commercial |
$44.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$56.19
|
| Rate for Payer: Networks By Design Commercial |
$48.70
|
| Rate for Payer: Prime Health Services Commercial |
$63.68
|
| Rate for Payer: Riverside University Health System MISP |
$29.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.46
|
| Rate for Payer: United Healthcare All Other HMO |
$37.46
|
| Rate for Payer: United Healthcare HMO Rider |
$37.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.68
|
| Rate for Payer: Vantage Medical Group Senior |
$63.68
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
NDC 0781714483
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.59
|
| Rate for Payer: Blue Shield of California Commercial |
$8.27
|
| Rate for Payer: Blue Shield of California EPN |
$5.21
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.44
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.79
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.09
|
| Rate for Payer: Vantage Medical Group Senior |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
NDC 0781714458
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.59
|
| Rate for Payer: Blue Shield of California Commercial |
$8.27
|
| Rate for Payer: Blue Shield of California EPN |
$5.21
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.44
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.79
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.09
|
| Rate for Payer: Vantage Medical Group Senior |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
NDC 0781714483
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California EPN |
$6.58
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.44
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.79
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
NDC 0781714458
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California EPN |
$6.58
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.44
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$9.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$7.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.79
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0781713358
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$17.87
|
| Rate for Payer: Blue Shield of California EPN |
$11.23
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Central Health Plan Commercial |
$17.82
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0781713354
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$17.87
|
| Rate for Payer: Blue Shield of California EPN |
$11.23
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Central Health Plan Commercial |
$17.82
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0781713358
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.96
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$8.89
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Central Health Plan Commercial |
$17.82
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Vantage Medical Group Senior |
$18.94
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0781713354
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.96
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$8.89
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Central Health Plan Commercial |
$17.82
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Vantage Medical Group Senior |
$18.94
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 6516222804
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$17.61 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California EPN |
$9.86
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Central Health Plan Commercial |
$15.66
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Senior |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 6516222808
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$17.61 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California EPN |
$9.86
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Central Health Plan Commercial |
$15.66
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Senior |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
NDC 6516222808
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$17.61 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.38
|
| Rate for Payer: Blue Shield of California Commercial |
$12.41
|
| Rate for Payer: Blue Shield of California EPN |
$7.81
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Central Health Plan Commercial |
$15.66
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Senior |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
| Rate for Payer: Riverside University Health System MISP |
$7.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
NDC 6516222804
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$17.61 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.38
|
| Rate for Payer: Blue Shield of California Commercial |
$12.41
|
| Rate for Payer: Blue Shield of California EPN |
$7.81
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Central Health Plan Commercial |
$15.66
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$13.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Senior |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
| Rate for Payer: Riverside University Health System MISP |
$7.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0378335299
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.96
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$8.89
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Central Health Plan Commercial |
$17.82
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Vantage Medical Group Senior |
$18.94
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0378335216
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$17.87
|
| Rate for Payer: Blue Shield of California EPN |
$11.23
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Central Health Plan Commercial |
$17.82
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0378335216
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.96
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$8.89
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Central Health Plan Commercial |
$17.82
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Vantage Medical Group Senior |
$18.94
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0378335299
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Blue Shield of California Commercial |
$17.87
|
| Rate for Payer: Blue Shield of California EPN |
$11.23
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Central Health Plan Commercial |
$17.82
|
| Rate for Payer: Cigna of CA HMO |
$15.60
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$18.94
|
| Rate for Payer: Global Benefits Group Commercial |
$13.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$14.48
|
| Rate for Payer: Prime Health Services Commercial |
$18.94
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 5186233201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 7095456410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 4280608701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 4280608701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 5186233201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 7095456410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
ESTRADIOL 1 MG TABLET [9967]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 4280608801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| 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: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| 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: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
