|
DEXAMETHASONE 4 MG TABLET [2327]
|
Facility
IP
|
$1.19
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1710170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.97
|
| Rate for Payer: Central Health Plan Commercial |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.85
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Galaxy Health WC |
$1.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Global Benefits Group Commercial |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$0.91
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.03
|
|
|
DEXAMETHASONE 6 MG TABLET [2328]
|
Facility
OP
|
$1.78
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1710185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: EPIC Health Plan Transplant |
$0.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$1.14
|
| Rate for Payer: BCBS Transplant Transplant |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Central Health Plan Commercial |
$1.52
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.42
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Riverside University Health MISP |
$0.71
|
| Rate for Payer: Riverside University Health MISP |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.62
|
| Rate for Payer: Vantage Medical Group Senior |
$1.62
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
DEXAMETHASONE 6 MG TABLET [2328]
|
Facility
IP
|
$1.78
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1710185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Central Health Plan Commercial |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$1.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
|
|
DEXAMETHASONE INTRAVITREAL INJECTION [192081]
|
Facility
OP
|
$0.93
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Central Health Plan Commercial |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.60
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$2.94
|
| Rate for Payer: Riverside University Health MISP |
$1.38
|
| Rate for Payer: Riverside University Health MISP |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.94
|
|
|
DEXAMETHASONE INTRAVITREAL INJECTION [192081]
|
Facility
IP
|
$0.93
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Central Health Plan Commercial |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$0.65
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$2.94
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$2.94
|
|
|
DEXAMETHASONE ORAL SOLUTION (IV FORM) 4 MG/ML [4080428]
|
Facility
OP
|
$0.62
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.47
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Riverside University Health MISP |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
DEXAMETHASONE ORAL SOLUTION (IV FORM) 4 MG/ML [4080428]
|
Facility
IP
|
$0.62
|
|
|
Service Code
|
CPT J8540
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: BCBS Transplant Transplant |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Central Health Plan Commercial |
$1.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.40
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Riverside University Health MISP |
$0.19
|
| Rate for Payer: Riverside University Health MISP |
$0.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.93
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.58
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]
|
Facility
OP
|
$1.72
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1730171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.29
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Riverside University Health MISP |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]
|
Facility
IP
|
$1.72
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1730171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]
|
Facility
IP
|
$1.86
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Central Health Plan Commercial |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$1.30
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$1.58
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$1.58
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.87
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$2.94
|
| Rate for Payer: Riverside University Health MISP |
$1.38
|
| Rate for Payer: Riverside University Health MISP |
$0.46
|
| Rate for Payer: Riverside University Health MISP |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$2.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.79
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
IP
|
$0.93
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Central Health Plan Commercial |
$2.77
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.94
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$2.94
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SYRINGE [114048]
|
Facility
OP
|
$3.47
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG114048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Central Health Plan Commercial |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$2.43
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.60
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.95
|
| Rate for Payer: Riverside University Health MISP |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2.95
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SYRINGE [114048]
|
Facility
IP
|
$3.47
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG114048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Central Health Plan Commercial |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$2.43
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.95
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [118427]
|
Facility
IP
|
$5.28
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG118427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.82
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$1.68
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$5.03
|
| Rate for Payer: Central Health Plan Commercial |
$4.22
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Galaxy Health WC |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$3.14
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.35
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [118427]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG118427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$3.17
|
| Rate for Payer: BCBS Transplant Transplant |
$1.26
|
| Rate for Payer: BCBS Transplant Transplant |
$5.40
|
| Rate for Payer: BCBS Transplant Transplant |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.68
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$4.22
|
| Rate for Payer: Central Health Plan Commercial |
$5.03
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Galaxy Health WC |
$5.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.75
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$3.14
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Prime Health Services Commercial |
$5.35
|
| Rate for Payer: Riverside University Health MISP |
$0.84
|
| Rate for Payer: Riverside University Health MISP |
$2.11
|
| Rate for Payer: Riverside University Health MISP |
$2.52
|
| Rate for Payer: Riverside University Health MISP |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1.78
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE [225593]
|
Facility
OP
|
$6.94
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG225593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$4.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Central Health Plan Commercial |
$5.55
|
| Rate for Payer: Cigna of CA HMO |
$4.86
|
| Rate for Payer: Cigna of CA PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.20
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Networks By Design Commercial |
$3.47
|
| Rate for Payer: Prime Health Services Commercial |
$5.90
|
| Rate for Payer: Riverside University Health MISP |
$2.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3.47
|
| Rate for Payer: United Healthcare HMO Rider |
$3.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5.90
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE [225593]
|
Facility
IP
|
$6.94
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG225593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5.20
|
| Rate for Payer: Blue Shield of California EPN |
$3.71
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Central Health Plan Commercial |
$5.55
|
| Rate for Payer: Cigna of CA HMO |
$4.86
|
| Rate for Payer: Cigna of CA PPO |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: Networks By Design Commercial |
$3.47
|
| Rate for Payer: Prime Health Services Commercial |
$5.90
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$3.25
|
|
|
Service Code
|
NDC 70860-605-03
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Central Health Plan Commercial |
$2.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.76
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
OP
|
$3.25
|
|
|
Service Code
|
NDC 42023-146-25
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.92
|
| Rate for Payer: BCBS Transplant Transplant |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Central Health Plan Commercial |
$2.60
|
| Rate for Payer: Cigna of CA HMO |
$2.08
|
| Rate for Payer: Cigna of CA PPO |
$2.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.44
|
| Rate for Payer: IEHP medi-cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.76
|
| Rate for Payer: Riverside University Health MISP |
$1.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.76
|
| Rate for Payer: Vantage Medical Group Senior |
$2.76
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$3.25
|
|
|
Service Code
|
NDC 70860-605-41
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.44
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Central Health Plan Commercial |
$2.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
| Rate for Payer: Networks By Design Commercial |
$2.11
|
| Rate for Payer: Prime Health Services Commercial |
$2.76
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$4.32
|
|
|
Service Code
|
NDC 55150-209-02
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Central Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
|
