|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
NDC 0527-0586-01
|
| Hospital Charge Code |
1711316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.18
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
OP
|
$0.66
|
|
|
Service Code
|
NDC 60687-369-11
|
| Hospital Charge Code |
1711316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: IEHP medi-cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: Riverside University Health MISP |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
NDC 0378-1610-01
|
| Hospital Charge Code |
1711316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
NDC 0591-0794-01
|
| Hospital Charge Code |
1711316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: BCBS Transplant Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.18
|
| Rate for Payer: IEHP medi-cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 51079-118-01
|
| Hospital Charge Code |
1711316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]
|
Facility
IP
|
$50.44
|
|
|
Service Code
|
CPT J0500
|
| Hospital Charge Code |
1720318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Blue Shield of California Commercial |
$37.83
|
| Rate for Payer: Blue Shield of California Commercial |
$11.07
|
| Rate for Payer: Blue Shield of California EPN |
$26.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.88
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cash Price |
$22.70
|
| Rate for Payer: Central Health Plan Commercial |
$11.81
|
| Rate for Payer: Central Health Plan Commercial |
$40.35
|
| Rate for Payer: Cigna of CA HMO |
$10.33
|
| Rate for Payer: Cigna of CA HMO |
$35.31
|
| Rate for Payer: Cigna of CA PPO |
$35.31
|
| Rate for Payer: Cigna of CA PPO |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.18
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Galaxy Health WC |
$42.87
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Global Benefits Group Commercial |
$30.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.09
|
| Rate for Payer: Multiplan Commercial |
$37.83
|
| Rate for Payer: Multiplan Commercial |
$11.07
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Networks By Design Commercial |
$25.22
|
| Rate for Payer: Prime Health Services Commercial |
$42.87
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]
|
Facility
OP
|
$50.44
|
|
|
Service Code
|
CPT J0500
|
| Hospital Charge Code |
1720318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$154.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$42.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.34
|
| Rate for Payer: BCBS Transplant Transplant |
$8.86
|
| Rate for Payer: BCBS Transplant Transplant |
$30.26
|
| Rate for Payer: Blue Shield of California Commercial |
$53.63
|
| Rate for Payer: Blue Shield of California Commercial |
$53.63
|
| Rate for Payer: Blue Shield of California EPN |
$48.75
|
| Rate for Payer: Blue Shield of California EPN |
$48.75
|
| Rate for Payer: Cash Price |
$22.70
|
| Rate for Payer: Cash Price |
$22.70
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Central Health Plan Commercial |
$40.35
|
| Rate for Payer: Central Health Plan Commercial |
$11.81
|
| Rate for Payer: Cigna of CA HMO |
$35.31
|
| Rate for Payer: Cigna of CA HMO |
$10.33
|
| Rate for Payer: Cigna of CA PPO |
$10.33
|
| Rate for Payer: Cigna of CA PPO |
$35.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.18
|
| Rate for Payer: Galaxy Health WC |
$42.87
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Global Benefits Group Commercial |
$30.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.83
|
| Rate for Payer: IEHP medi-cal |
$20.33
|
| Rate for Payer: IEHP medi-cal |
$20.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$11.07
|
| Rate for Payer: Multiplan Commercial |
$37.83
|
| Rate for Payer: Networks By Design Commercial |
$25.22
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$42.87
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
| Rate for Payer: Riverside University Health MISP |
$5.90
|
| Rate for Payer: Riverside University Health MISP |
$20.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO |
$25.22
|
| Rate for Payer: United Healthcare All Other HMO |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$25.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.55
|
| Rate for Payer: Vantage Medical Group Senior |
$42.87
|
| Rate for Payer: Vantage Medical Group Senior |
$12.55
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
NDC 60687-380-11
|
| Hospital Charge Code |
1711317
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: BCBS Transplant Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.41
|
| Rate for Payer: IEHP medi-cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
NDC 60687-380-01
|
| Hospital Charge Code |
1711317
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
NDC 60687-380-01
|
| Hospital Charge Code |
1711317
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: BCBS Transplant Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.41
|
| Rate for Payer: IEHP medi-cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
NDC 60687-380-11
|
| Hospital Charge Code |
1711317
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
IP
|
$0.33
|
|
|
Service Code
|
NDC 0591-0795-01
|
| Hospital Charge Code |
1711317
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
OP
|
$0.33
|
|
|
Service Code
|
NDC 0591-0795-01
|
| Hospital Charge Code |
1711317
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
DIFLUPREDNATE 0.05 % EYE DROPS [92859]
|
Facility
IP
|
$52.32
|
|
|
Service Code
|
NDC 0065-9240-07
|
| Hospital Charge Code |
NDG92859
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$47.09 |
| Rate for Payer: Blue Shield of California Commercial |
$39.24
|
| Rate for Payer: Blue Shield of California EPN |
$27.94
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Central Health Plan Commercial |
$41.86
|
| Rate for Payer: Cigna of CA HMO |
$36.62
|
| Rate for Payer: Cigna of CA PPO |
$36.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.93
|
| Rate for Payer: Galaxy Health WC |
$44.47
|
| Rate for Payer: Global Benefits Group Commercial |
$31.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.46
|
| Rate for Payer: Multiplan Commercial |
$39.24
|
| Rate for Payer: Networks By Design Commercial |
$34.01
|
| Rate for Payer: Prime Health Services Commercial |
$44.47
|
|
|
DIFLUPREDNATE 0.05 % EYE DROPS [92859]
|
Facility
OP
|
$52.32
|
|
|
Service Code
|
NDC 0065-9240-07
|
| Hospital Charge Code |
NDG92859
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$47.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.91
|
| Rate for Payer: BCBS Transplant Transplant |
$31.39
|
| Rate for Payer: Blue Shield of California Commercial |
$32.91
|
| Rate for Payer: Blue Shield of California EPN |
$25.58
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Central Health Plan Commercial |
$41.86
|
| Rate for Payer: Cigna of CA HMO |
$36.62
|
| Rate for Payer: Cigna of CA PPO |
$36.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.93
|
| Rate for Payer: Galaxy Health WC |
$44.47
|
| Rate for Payer: Global Benefits Group Commercial |
$31.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.24
|
| Rate for Payer: IEHP medi-cal |
$18.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.46
|
| Rate for Payer: Multiplan Commercial |
$39.24
|
| Rate for Payer: Networks By Design Commercial |
$34.01
|
| Rate for Payer: Prime Health Services Commercial |
$44.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.39
|
| Rate for Payer: Riverside University Health MISP |
$20.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.16
|
| Rate for Payer: United Healthcare All Other HMO |
$26.16
|
| Rate for Payer: United Healthcare HMO Rider |
$26.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.47
|
| Rate for Payer: Vantage Medical Group Senior |
$44.47
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
IP
|
$8,466.40
|
|
|
Service Code
|
APR-DRG 2401
|
| Min. Negotiated Rate |
$7,104.67 |
| Max. Negotiated Rate |
$8,466.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,104.67
|
| Rate for Payer: IEHP medi-cal |
$8,466.40
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
IP
|
$21,934.14
|
|
|
Service Code
|
APR-DRG 2404
|
| Min. Negotiated Rate |
$18,406.27 |
| Max. Negotiated Rate |
$21,934.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,406.27
|
| Rate for Payer: IEHP medi-cal |
$21,934.14
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
IP
|
$9,785.15
|
|
|
Service Code
|
APR-DRG 2402
|
| Min. Negotiated Rate |
$8,211.31 |
| Max. Negotiated Rate |
$9,785.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,211.31
|
| Rate for Payer: IEHP medi-cal |
$9,785.15
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
IP
|
$13,343.62
|
|
|
Service Code
|
APR-DRG 2403
|
| Min. Negotiated Rate |
$11,197.44 |
| Max. Negotiated Rate |
$13,343.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,197.44
|
| Rate for Payer: IEHP medi-cal |
$13,343.62
|
|
|
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION [9853]
|
Facility
IP
|
$151.63
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.33 |
| Max. Negotiated Rate |
$136.47 |
| Rate for Payer: Blue Shield of California Commercial |
$113.72
|
| Rate for Payer: Blue Shield of California EPN |
$80.97
|
| Rate for Payer: Cash Price |
$68.23
|
| Rate for Payer: Central Health Plan Commercial |
$121.30
|
| Rate for Payer: Cigna of CA HMO |
$106.14
|
| Rate for Payer: Cigna of CA PPO |
$106.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.65
|
| Rate for Payer: Galaxy Health WC |
$128.89
|
| Rate for Payer: Global Benefits Group Commercial |
$90.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.33
|
| Rate for Payer: Multiplan Commercial |
$113.72
|
| Rate for Payer: Networks By Design Commercial |
$75.82
|
| Rate for Payer: Prime Health Services Commercial |
$128.89
|
|
|
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION [9853]
|
Facility
OP
|
$151.63
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$136.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$128.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$83.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$83.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.79
|
| Rate for Payer: BCBS Transplant Transplant |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.74
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Cash Price |
$68.23
|
| Rate for Payer: Cash Price |
$68.23
|
| Rate for Payer: Central Health Plan Commercial |
$121.30
|
| Rate for Payer: Cigna of CA HMO |
$106.14
|
| Rate for Payer: Cigna of CA PPO |
$106.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.65
|
| Rate for Payer: Galaxy Health WC |
$128.89
|
| Rate for Payer: Global Benefits Group Commercial |
$90.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$113.72
|
| Rate for Payer: IEHP medi-cal |
$7.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.33
|
| Rate for Payer: Multiplan Commercial |
$113.72
|
| Rate for Payer: Networks By Design Commercial |
$75.82
|
| Rate for Payer: Prime Health Services Commercial |
$128.89
|
| Rate for Payer: Riverside University Health MISP |
$60.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.82
|
| Rate for Payer: United Healthcare All Other HMO |
$75.82
|
| Rate for Payer: United Healthcare HMO Rider |
$75.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.89
|
| Rate for Payer: Vantage Medical Group Senior |
$128.89
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-11
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
OP
|
$1.42
|
|
|
Service Code
|
NDC 0143-1240-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$0.99
|
| Rate for Payer: Cigna of CA PPO |
$0.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.06
|
| Rate for Payer: IEHP medi-cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.85
|
| Rate for Payer: Riverside University Health MISP |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO |
$0.71
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: Vantage Medical Group Senior |
$1.21
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.42
|
|
|
Service Code
|
NDC 0143-1240-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$0.99
|
| Rate for Payer: Cigna of CA PPO |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.21
|
|
