|
BENZTROPINE 1 MG/ML INJECTION SOLUTION [9259]
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT J0515
|
| Hospital Charge Code |
1720290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Blue Shield of California Commercial |
$24.75
|
| Rate for Payer: Blue Shield of California Commercial |
$21.15
|
| Rate for Payer: Blue Shield of California Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California EPN |
$19.22
|
| Rate for Payer: Blue Shield of California EPN |
$17.62
|
| Rate for Payer: Blue Shield of California EPN |
$15.06
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$22.56
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$19.74
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$19.74
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$23.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$21.15
|
| Rate for Payer: Networks By Design Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.10
|
| Rate for Payer: Prime Health Services Commercial |
$23.97
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
OP
|
$0.19
|
|
|
Service Code
|
NDC 69315-137-01
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
IP
|
$0.19
|
|
|
Service Code
|
NDC 0603-2434-21
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
IP
|
$0.19
|
|
|
Service Code
|
NDC 69315-137-01
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
OP
|
$0.19
|
|
|
Service Code
|
NDC 0603-2438-21
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
OP
|
$0.19
|
|
|
Service Code
|
NDC 0603-2434-21
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
BENZTROPINE 1 MG TABLET [999]
|
Facility
IP
|
$0.19
|
|
|
Service Code
|
NDC 0603-2438-21
|
| Hospital Charge Code |
1710776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
BENZTROPINE 2 MG TABLET [1000]
|
Facility
IP
|
$0.25
|
|
|
Service Code
|
NDC 0603-2439-21
|
| Hospital Charge Code |
1710775
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| 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: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| 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 |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
BENZTROPINE 2 MG TABLET [1000]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 76385-105-01
|
| Hospital Charge Code |
1710775
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
BENZTROPINE 2 MG TABLET [1000]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
NDC 0603-2439-21
|
| Hospital Charge Code |
1710775
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| 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 |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| 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 |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.19
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| 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 |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| 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 |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
BENZTROPINE 2 MG TABLET [1000]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 76385-105-01
|
| Hospital Charge Code |
1710775
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]
|
Facility
OP
|
$8.98
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
1720213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$42.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.55
|
| Rate for Payer: BCBS Transplant Transplant |
$5.99
|
| Rate for Payer: BCBS Transplant Transplant |
$5.39
|
| Rate for Payer: BCBS Transplant Transplant |
$7.93
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Blue Shield of California EPN |
$8.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.98
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$7.98
|
| Rate for Payer: Central Health Plan Commercial |
$10.57
|
| Rate for Payer: Central Health Plan Commercial |
$7.18
|
| Rate for Payer: Cigna of CA HMO |
$6.99
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$6.99
|
| Rate for Payer: Cigna of CA PPO |
$9.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.99
|
| Rate for Payer: Galaxy Health WC |
$8.48
|
| Rate for Payer: Galaxy Health WC |
$11.23
|
| Rate for Payer: Galaxy Health WC |
$7.63
|
| Rate for Payer: Global Benefits Group Commercial |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.93
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.91
|
| Rate for Payer: IEHP medi-cal |
$7.28
|
| Rate for Payer: IEHP medi-cal |
$7.28
|
| Rate for Payer: IEHP medi-cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$9.91
|
| Rate for Payer: Multiplan Commercial |
$7.48
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$4.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$7.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.48
|
| Rate for Payer: Riverside University Health MISP |
$3.99
|
| Rate for Payer: Riverside University Health MISP |
$3.59
|
| Rate for Payer: Riverside University Health MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Other HMO |
$4.49
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4.99
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.49
|
| Rate for Payer: United Healthcare HMO Rider |
$4.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.23
|
| Rate for Payer: Vantage Medical Group Senior |
$11.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.63
|
| Rate for Payer: Vantage Medical Group Senior |
$8.48
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION [9266]
|
Facility
IP
|
$13.21
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
1720213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.89 |
| Rate for Payer: Blue Shield of California Commercial |
$9.91
|
| Rate for Payer: Blue Shield of California Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$7.48
|
| Rate for Payer: Blue Shield of California EPN |
$4.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.33
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Central Health Plan Commercial |
$7.98
|
| Rate for Payer: Central Health Plan Commercial |
$10.57
|
| Rate for Payer: Central Health Plan Commercial |
$7.18
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$6.99
|
| Rate for Payer: Cigna of CA HMO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$9.25
|
| Rate for Payer: Cigna of CA PPO |
$6.99
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.99
|
| Rate for Payer: Galaxy Health WC |
$8.48
|
| Rate for Payer: Galaxy Health WC |
$11.23
|
| Rate for Payer: Galaxy Health WC |
$7.63
|
| Rate for Payer: Global Benefits Group Commercial |
$7.93
|
| Rate for Payer: Global Benefits Group Commercial |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$9.91
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$4.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$7.63
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM [9175]
|
Facility
OP
|
$0.56
|
|
|
Service Code
|
NDC 68462-290-17
|
| Hospital Charge Code |
1743496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: BCBS Transplant Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.42
|
| Rate for Payer: IEHP medi-cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM [9175]
|
Facility
IP
|
$0.56
|
|
|
Service Code
|
NDC 68462-290-17
|
| Hospital Charge Code |
1743496
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL OINTMENT [9178]
|
Facility
IP
|
$2.84
|
|
|
Service Code
|
NDC 0472-0382-45
|
| Hospital Charge Code |
1743379
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL OINTMENT [9178]
|
Facility
OP
|
$2.84
|
|
|
Service Code
|
NDC 0472-0382-45
|
| Hospital Charge Code |
1743379
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.68
|
| Rate for Payer: BCBS Transplant Transplant |
$1.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.13
|
| Rate for Payer: IEHP medi-cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Networks By Design Commercial |
$1.85
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: Riverside University Health MISP |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % LOTION [1028]
|
Facility
IP
|
$0.80
|
|
|
Service Code
|
NDC 0168-0057-60
|
| Hospital Charge Code |
1743383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % LOTION [1028]
|
Facility
OP
|
$0.80
|
|
|
Service Code
|
NDC 0168-0057-60
|
| Hospital Charge Code |
1743383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: BCBS Transplant Transplant |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.60
|
| Rate for Payer: IEHP medi-cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.52
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM [1027]
|
Facility
OP
|
$2.59
|
|
|
Service Code
|
NDC 0472-0380-15
|
| Hospital Charge Code |
1743546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.53
|
| Rate for Payer: BCBS Transplant Transplant |
$1.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$1.81
|
| Rate for Payer: Cigna of CA PPO |
$1.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.94
|
| Rate for Payer: IEHP medi-cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$2.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.55
|
| Rate for Payer: Riverside University Health MISP |
$1.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2.20
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM [1027]
|
Facility
IP
|
$2.59
|
|
|
Service Code
|
NDC 0472-0380-15
|
| Hospital Charge Code |
1743546
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.38
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$1.81
|
| Rate for Payer: Cigna of CA PPO |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$2.20
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
OP
|
$3.94
|
|
|
Service Code
|
NDC 0168-0056-15
|
| Hospital Charge Code |
1743377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.33
|
| Rate for Payer: BCBS Transplant Transplant |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.93
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Central Health Plan Commercial |
$3.15
|
| Rate for Payer: Cigna of CA HMO |
$2.76
|
| Rate for Payer: Cigna of CA PPO |
$2.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.96
|
| Rate for Payer: IEHP medi-cal |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.36
|
| Rate for Payer: Riverside University Health MISP |
$1.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
OP
|
$3.14
|
|
|
Service Code
|
NDC 0472-0381-15
|
| Hospital Charge Code |
1743377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: BCBS Transplant Transplant |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Central Health Plan Commercial |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.36
|
| Rate for Payer: IEHP medi-cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.88
|
| Rate for Payer: Riverside University Health MISP |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Vantage Medical Group Senior |
$2.67
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
IP
|
$3.14
|
|
|
Service Code
|
NDC 0472-0381-15
|
| Hospital Charge Code |
1743377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Central Health Plan Commercial |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [1029]
|
Facility
IP
|
$3.94
|
|
|
Service Code
|
NDC 0168-0056-15
|
| Hospital Charge Code |
1743377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Blue Shield of California Commercial |
$2.96
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Central Health Plan Commercial |
$3.15
|
| Rate for Payer: Cigna of CA HMO |
$2.76
|
| Rate for Payer: Cigna of CA PPO |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.35
|
|
