|
DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION [9828]
|
Facility
IP
|
$0.67
|
|
|
Service Code
|
CPT Q9963
|
| Hospital Charge Code |
NDG9828
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.13 |
| 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 |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| 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 |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 0378-0477-01
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 0378-0477-01
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 51079-286-01
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 51079-286-01
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 51079-286-20
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
DIAZEPAM 10 MG TABLET [2403]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 51079-286-20
|
| Hospital Charge Code |
1730082
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
DIAZEPAM 12.5 MG-15 MG-17.5 MG-20 MG RECTAL KIT [87869]
|
Facility
IP
|
$420.90
|
|
|
Service Code
|
NDC 0187-0659-20
|
| Hospital Charge Code |
ERX87869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$84.18 |
| 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 |
$315.68
|
| Rate for Payer: Blue Shield of California EPN |
$224.76
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Central Health Plan Commercial |
$336.72
|
| Rate for Payer: Cigna of CA HMO |
$294.63
|
| Rate for Payer: Cigna of CA PPO |
$294.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.36
|
| Rate for Payer: Galaxy Health WC |
$357.76
|
| Rate for Payer: Global Benefits Group Commercial |
$252.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.18
|
| Rate for Payer: Multiplan Commercial |
$315.68
|
| Rate for Payer: Networks By Design Commercial |
$273.58
|
| Rate for Payer: Prime Health Services Commercial |
$357.76
|
|
|
DIAZEPAM 12.5 MG-15 MG-17.5 MG-20 MG RECTAL KIT [87869]
|
Facility
OP
|
$420.90
|
|
|
Service Code
|
NDC 0187-0659-20
|
| Hospital Charge Code |
ERX87869
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$84.18 |
| Max. Negotiated Rate |
$378.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$255.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$357.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.67
|
| Rate for Payer: BCBS Transplant Transplant |
$252.54
|
| Rate for Payer: Blue Shield of California Commercial |
$264.75
|
| Rate for Payer: Blue Shield of California EPN |
$205.82
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Central Health Plan Commercial |
$336.72
|
| Rate for Payer: Cigna of CA HMO |
$294.63
|
| Rate for Payer: Cigna of CA PPO |
$294.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.36
|
| Rate for Payer: Galaxy Health WC |
$357.76
|
| Rate for Payer: Global Benefits Group Commercial |
$252.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$315.68
|
| Rate for Payer: IEHP medi-cal |
$147.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.18
|
| Rate for Payer: Multiplan Commercial |
$315.68
|
| Rate for Payer: Networks By Design Commercial |
$273.58
|
| Rate for Payer: Prime Health Services Commercial |
$357.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$252.54
|
| Rate for Payer: Riverside University Health MISP |
$168.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.45
|
| Rate for Payer: United Healthcare All Other HMO |
$210.45
|
| Rate for Payer: United Healthcare HMO Rider |
$210.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.76
|
| Rate for Payer: Vantage Medical Group Senior |
$357.76
|
|
|
DIAZEPAM 2.5 MG RECTAL KIT [87865]
|
Facility
OP
|
$354.82
|
|
|
Service Code
|
NDC 66490-650-20
|
| Hospital Charge Code |
1748085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.96 |
| Max. Negotiated Rate |
$319.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$215.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$301.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$195.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.63
|
| Rate for Payer: BCBS Transplant Transplant |
$212.89
|
| Rate for Payer: Blue Shield of California Commercial |
$223.18
|
| Rate for Payer: Blue Shield of California EPN |
$173.51
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Central Health Plan Commercial |
$283.86
|
| Rate for Payer: Cigna of CA HMO |
$248.37
|
| Rate for Payer: Cigna of CA PPO |
$248.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$301.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$141.93
|
| Rate for Payer: Galaxy Health WC |
$301.60
|
| Rate for Payer: Global Benefits Group Commercial |
$212.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$266.12
|
| Rate for Payer: IEHP medi-cal |
$124.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.96
|
| Rate for Payer: Multiplan Commercial |
$266.12
|
| Rate for Payer: Networks By Design Commercial |
$230.63
|
| Rate for Payer: Prime Health Services Commercial |
$301.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$212.89
|
| Rate for Payer: Riverside University Health MISP |
$141.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.41
|
| Rate for Payer: United Healthcare All Other HMO |
$177.41
|
| Rate for Payer: United Healthcare HMO Rider |
$177.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$301.60
|
| Rate for Payer: Vantage Medical Group Senior |
$301.60
|
|
|
DIAZEPAM 2.5 MG RECTAL KIT [87865]
|
Facility
IP
|
$354.82
|
|
|
Service Code
|
NDC 66490-650-20
|
| Hospital Charge Code |
1748085
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.96 |
| 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 |
$266.12
|
| Rate for Payer: Blue Shield of California EPN |
$189.47
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Central Health Plan Commercial |
$283.86
|
| Rate for Payer: Cigna of CA HMO |
$248.37
|
| Rate for Payer: Cigna of CA PPO |
$248.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.93
|
| Rate for Payer: Galaxy Health WC |
$301.60
|
| Rate for Payer: Global Benefits Group Commercial |
$212.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.96
|
| Rate for Payer: Multiplan Commercial |
$266.12
|
| Rate for Payer: Networks By Design Commercial |
$230.63
|
| Rate for Payer: Prime Health Services Commercial |
$301.60
|
|
|
DIAZEPAM 2 MG TABLET [2404]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 51079-284-01
|
| Hospital Charge Code |
1730080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
DIAZEPAM 2 MG TABLET [2404]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 51079-284-01
|
| Hospital Charge Code |
1730080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
DIAZEPAM 2 MG TABLET [2404]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 51079-284-20
|
| Hospital Charge Code |
1730080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
DIAZEPAM 2 MG TABLET [2404]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 51079-284-20
|
| Hospital Charge Code |
1730080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [154274]
|
Facility
IP
|
$0.92
|
|
|
Service Code
|
NDC 68094-750-62
|
| Hospital Charge Code |
NDG154274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| 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 |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.78
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [154274]
|
Facility
OP
|
$0.92
|
|
|
Service Code
|
NDC 68094-750-59
|
| Hospital Charge Code |
NDG154274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.54
|
| Rate for Payer: BCBS Transplant Transplant |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.69
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: Riverside University Health MISP |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.78
|
| Rate for Payer: Vantage Medical Group Senior |
$0.78
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [154274]
|
Facility
IP
|
$0.92
|
|
|
Service Code
|
NDC 68094-750-59
|
| Hospital Charge Code |
NDG154274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| 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 |
$0.69
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.78
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLUTION [154274]
|
Facility
OP
|
$0.92
|
|
|
Service Code
|
NDC 68094-750-62
|
| Hospital Charge Code |
NDG154274
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.54
|
| Rate for Payer: BCBS Transplant Transplant |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.78
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.69
|
| Rate for Payer: IEHP medi-cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.69
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: Riverside University Health MISP |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO |
$0.46
|
| Rate for Payer: United Healthcare HMO Rider |
$0.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.78
|
| Rate for Payer: Vantage Medical Group Senior |
$0.78
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLUTION [2402]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 0054-3188-63
|
| Hospital Charge Code |
1715521
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| 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 |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLUTION [2402]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 0054-3188-63
|
| Hospital Charge Code |
1715521
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT [87867]
|
Facility
OP
|
$420.90
|
|
|
Service Code
|
NDC 0187-0658-20
|
| Hospital Charge Code |
1748083
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$84.18 |
| Max. Negotiated Rate |
$378.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$255.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$357.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.67
|
| Rate for Payer: BCBS Transplant Transplant |
$252.54
|
| Rate for Payer: Blue Shield of California Commercial |
$264.75
|
| Rate for Payer: Blue Shield of California EPN |
$205.82
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Central Health Plan Commercial |
$336.72
|
| Rate for Payer: Cigna of CA HMO |
$294.63
|
| Rate for Payer: Cigna of CA PPO |
$294.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.36
|
| Rate for Payer: Galaxy Health WC |
$357.76
|
| Rate for Payer: Global Benefits Group Commercial |
$252.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$315.68
|
| Rate for Payer: IEHP medi-cal |
$147.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.18
|
| Rate for Payer: Multiplan Commercial |
$315.68
|
| Rate for Payer: Networks By Design Commercial |
$273.58
|
| Rate for Payer: Prime Health Services Commercial |
$357.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$252.54
|
| Rate for Payer: Riverside University Health MISP |
$168.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.45
|
| Rate for Payer: United Healthcare All Other HMO |
$210.45
|
| Rate for Payer: United Healthcare HMO Rider |
$210.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.76
|
| Rate for Payer: Vantage Medical Group Senior |
$357.76
|
|
|
DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT [87867]
|
Facility
IP
|
$420.90
|
|
|
Service Code
|
NDC 0187-0658-20
|
| Hospital Charge Code |
1748083
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$84.18 |
| 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 |
$315.68
|
| Rate for Payer: Blue Shield of California EPN |
$224.76
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Cash Price |
$189.41
|
| Rate for Payer: Central Health Plan Commercial |
$336.72
|
| Rate for Payer: Cigna of CA HMO |
$294.63
|
| Rate for Payer: Cigna of CA PPO |
$294.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.36
|
| Rate for Payer: Galaxy Health WC |
$357.76
|
| Rate for Payer: Global Benefits Group Commercial |
$252.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.18
|
| Rate for Payer: Multiplan Commercial |
$315.68
|
| Rate for Payer: Networks By Design Commercial |
$273.58
|
| Rate for Payer: Prime Health Services Commercial |
$357.76
|
|
|
DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]
|
Facility
OP
|
$20.20
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
1737041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$33.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.16
|
| Rate for Payer: BCBS Transplant Transplant |
$12.12
|
| Rate for Payer: Blue Shield of California Commercial |
$12.08
|
| Rate for Payer: Blue Shield of California EPN |
$10.99
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Central Health Plan Commercial |
$16.16
|
| Rate for Payer: Cigna of CA HMO |
$14.14
|
| Rate for Payer: Cigna of CA PPO |
$14.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$17.17
|
| Rate for Payer: Global Benefits Group Commercial |
$12.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.15
|
| Rate for Payer: IEHP medi-cal |
$5.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$15.15
|
| Rate for Payer: Networks By Design Commercial |
$10.10
|
| Rate for Payer: Prime Health Services Commercial |
$17.17
|
| Rate for Payer: Riverside University Health MISP |
$8.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.10
|
| Rate for Payer: United Healthcare All Other HMO |
$10.10
|
| Rate for Payer: United Healthcare HMO Rider |
$10.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.17
|
| Rate for Payer: Vantage Medical Group Senior |
$17.17
|
|
|
DIAZEPAM 5 MG/ML INJECTION SYRINGE [106278]
|
Facility
IP
|
$20.20
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
1737041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.04 |
| 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 |
$15.15
|
| Rate for Payer: Blue Shield of California EPN |
$10.79
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Central Health Plan Commercial |
$16.16
|
| Rate for Payer: Cigna of CA HMO |
$14.14
|
| Rate for Payer: Cigna of CA PPO |
$14.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$17.17
|
| Rate for Payer: Global Benefits Group Commercial |
$12.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$15.15
|
| Rate for Payer: Networks By Design Commercial |
$10.10
|
| Rate for Payer: Prime Health Services Commercial |
$17.17
|
|
