|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
OP
|
$1.43
|
|
|
Service Code
|
NDC 0713-0326-15
|
| Hospital Charge Code |
1743469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.07
|
| Rate for Payer: IEHP medi-cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: Riverside University Health MISP |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
IP
|
$1.43
|
|
|
Service Code
|
NDC 0713-0326-15
|
| Hospital Charge Code |
1743469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
OP
|
$1.43
|
|
|
Service Code
|
NDC 51672-1269-1
|
| Hospital Charge Code |
1743469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.07
|
| Rate for Payer: IEHP medi-cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: Riverside University Health MISP |
$0.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM [1031]
|
Facility
IP
|
$1.43
|
|
|
Service Code
|
NDC 51672-1269-1
|
| Hospital Charge Code |
1743469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.07
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
IP
|
$1.30
|
|
|
Service Code
|
NDC 0168-0033-15
|
| Hospital Charge Code |
NDG1033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
IP
|
$0.89
|
|
|
Service Code
|
NDC 0168-0033-46
|
| Hospital Charge Code |
1743276
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.76
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
OP
|
$1.30
|
|
|
Service Code
|
NDC 0472-0371-15
|
| Hospital Charge Code |
NDG1033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: BCBS Transplant Transplant |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.98
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: Riverside University Health MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
OP
|
$1.30
|
|
|
Service Code
|
NDC 0168-0033-15
|
| Hospital Charge Code |
NDG1033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: BCBS Transplant Transplant |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.98
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: Riverside University Health MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
IP
|
$1.30
|
|
|
Service Code
|
NDC 0472-0371-15
|
| Hospital Charge Code |
NDG1033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
OP
|
$0.89
|
|
|
Service Code
|
NDC 0168-0033-46
|
| Hospital Charge Code |
1743276
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: BCBS Transplant Transplant |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.76
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.67
|
| Rate for Payer: IEHP medi-cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Prime Health Services Commercial |
$0.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: Riverside University Health MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: Vantage Medical Group Senior |
$0.76
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION [19703]
|
Facility
IP
|
$39.13
|
|
|
Service Code
|
NDC 0065-0246-10
|
| Hospital Charge Code |
NDG19703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Blue Shield of California Commercial |
$29.35
|
| Rate for Payer: Blue Shield of California EPN |
$20.90
|
| Rate for Payer: Cash Price |
$17.61
|
| Rate for Payer: Central Health Plan Commercial |
$31.30
|
| Rate for Payer: Cigna of CA HMO |
$27.39
|
| Rate for Payer: Cigna of CA PPO |
$27.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.65
|
| Rate for Payer: Galaxy Health WC |
$33.26
|
| Rate for Payer: Global Benefits Group Commercial |
$23.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.83
|
| Rate for Payer: Multiplan Commercial |
$29.35
|
| Rate for Payer: Networks By Design Commercial |
$25.43
|
| Rate for Payer: Prime Health Services Commercial |
$33.26
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION [19703]
|
Facility
OP
|
$39.13
|
|
|
Service Code
|
NDC 0065-0246-10
|
| Hospital Charge Code |
NDG19703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.12
|
| Rate for Payer: BCBS Transplant Transplant |
$23.48
|
| Rate for Payer: Blue Shield of California Commercial |
$24.61
|
| Rate for Payer: Blue Shield of California EPN |
$19.13
|
| Rate for Payer: Cash Price |
$17.61
|
| Rate for Payer: Central Health Plan Commercial |
$31.30
|
| Rate for Payer: Cigna of CA HMO |
$27.39
|
| Rate for Payer: Cigna of CA PPO |
$27.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.65
|
| Rate for Payer: Galaxy Health WC |
$33.26
|
| Rate for Payer: Global Benefits Group Commercial |
$23.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.35
|
| Rate for Payer: IEHP medi-cal |
$13.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.83
|
| Rate for Payer: Multiplan Commercial |
$29.35
|
| Rate for Payer: Networks By Design Commercial |
$25.43
|
| Rate for Payer: Prime Health Services Commercial |
$33.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.48
|
| Rate for Payer: Riverside University Health MISP |
$15.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.56
|
| Rate for Payer: United Healthcare All Other HMO |
$19.56
|
| Rate for Payer: United Healthcare HMO Rider |
$19.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.26
|
| Rate for Payer: Vantage Medical Group Senior |
$33.26
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
IP
|
$12.18
|
|
|
Service Code
|
NDC 17478-705-10
|
| Hospital Charge Code |
1740210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Blue Shield of California Commercial |
$9.14
|
| Rate for Payer: Blue Shield of California EPN |
$6.50
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Central Health Plan Commercial |
$9.74
|
| Rate for Payer: Cigna of CA HMO |
$8.53
|
| Rate for Payer: Cigna of CA PPO |
$8.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.87
|
| Rate for Payer: Galaxy Health WC |
$10.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$9.14
|
| Rate for Payer: Networks By Design Commercial |
$7.92
|
| Rate for Payer: Prime Health Services Commercial |
$10.35
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
IP
|
$11.38
|
|
|
Service Code
|
NDC 61314-245-03
|
| Hospital Charge Code |
1740211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.24 |
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.08
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Central Health Plan Commercial |
$9.10
|
| Rate for Payer: Cigna of CA HMO |
$7.97
|
| Rate for Payer: Cigna of CA PPO |
$7.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: Galaxy Health WC |
$9.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
| Rate for Payer: Networks By Design Commercial |
$7.40
|
| Rate for Payer: Prime Health Services Commercial |
$9.67
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
OP
|
$12.18
|
|
|
Service Code
|
NDC 17478-705-10
|
| Hospital Charge Code |
1740210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.20
|
| Rate for Payer: BCBS Transplant Transplant |
$7.31
|
| Rate for Payer: Blue Shield of California Commercial |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Central Health Plan Commercial |
$9.74
|
| Rate for Payer: Cigna of CA HMO |
$8.53
|
| Rate for Payer: Cigna of CA PPO |
$8.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.87
|
| Rate for Payer: Galaxy Health WC |
$10.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.14
|
| Rate for Payer: IEHP medi-cal |
$4.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$9.14
|
| Rate for Payer: Networks By Design Commercial |
$7.92
|
| Rate for Payer: Prime Health Services Commercial |
$10.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.31
|
| Rate for Payer: Riverside University Health MISP |
$4.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.09
|
| Rate for Payer: United Healthcare All Other HMO |
$6.09
|
| Rate for Payer: United Healthcare HMO Rider |
$6.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.35
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
OP
|
$12.24
|
|
|
Service Code
|
NDC 61314-245-01
|
| Hospital Charge Code |
1740210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.23
|
| Rate for Payer: BCBS Transplant Transplant |
$7.34
|
| Rate for Payer: Blue Shield of California Commercial |
$7.70
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Central Health Plan Commercial |
$9.79
|
| Rate for Payer: Cigna of CA HMO |
$8.57
|
| Rate for Payer: Cigna of CA PPO |
$8.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.90
|
| Rate for Payer: Galaxy Health WC |
$10.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.18
|
| Rate for Payer: IEHP medi-cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
| Rate for Payer: Networks By Design Commercial |
$7.96
|
| Rate for Payer: Prime Health Services Commercial |
$10.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.34
|
| Rate for Payer: Riverside University Health MISP |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO |
$6.12
|
| Rate for Payer: United Healthcare HMO Rider |
$6.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10.40
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
IP
|
$11.32
|
|
|
Service Code
|
NDC 17478-705-11
|
| Hospital Charge Code |
1740211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.19 |
| Rate for Payer: Blue Shield of California Commercial |
$8.49
|
| Rate for Payer: Blue Shield of California EPN |
$6.04
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$9.06
|
| Rate for Payer: Cigna of CA HMO |
$7.92
|
| Rate for Payer: Cigna of CA PPO |
$7.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: Galaxy Health WC |
$9.62
|
| Rate for Payer: Global Benefits Group Commercial |
$6.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.49
|
| Rate for Payer: Networks By Design Commercial |
$7.36
|
| Rate for Payer: Prime Health Services Commercial |
$9.62
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
IP
|
$12.24
|
|
|
Service Code
|
NDC 61314-245-01
|
| Hospital Charge Code |
1740210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Blue Shield of California Commercial |
$9.18
|
| Rate for Payer: Blue Shield of California EPN |
$6.54
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Central Health Plan Commercial |
$9.79
|
| Rate for Payer: Cigna of CA HMO |
$8.57
|
| Rate for Payer: Cigna of CA PPO |
$8.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.90
|
| Rate for Payer: Galaxy Health WC |
$10.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
| Rate for Payer: Networks By Design Commercial |
$7.96
|
| Rate for Payer: Prime Health Services Commercial |
$10.40
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
OP
|
$11.38
|
|
|
Service Code
|
NDC 61314-245-03
|
| Hospital Charge Code |
1740211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.72
|
| Rate for Payer: BCBS Transplant Transplant |
$6.83
|
| Rate for Payer: Blue Shield of California Commercial |
$7.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Central Health Plan Commercial |
$9.10
|
| Rate for Payer: Cigna of CA HMO |
$7.97
|
| Rate for Payer: Cigna of CA PPO |
$7.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.55
|
| Rate for Payer: Galaxy Health WC |
$9.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.54
|
| Rate for Payer: IEHP medi-cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
| Rate for Payer: Networks By Design Commercial |
$7.40
|
| Rate for Payer: Prime Health Services Commercial |
$9.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.83
|
| Rate for Payer: Riverside University Health MISP |
$4.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.69
|
| Rate for Payer: United Healthcare All Other HMO |
$5.69
|
| Rate for Payer: United Healthcare HMO Rider |
$5.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.67
|
| Rate for Payer: Vantage Medical Group Senior |
$9.67
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
OP
|
$11.32
|
|
|
Service Code
|
NDC 17478-705-11
|
| Hospital Charge Code |
1740211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.69
|
| Rate for Payer: BCBS Transplant Transplant |
$6.79
|
| Rate for Payer: Blue Shield of California Commercial |
$7.12
|
| Rate for Payer: Blue Shield of California EPN |
$5.54
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$9.06
|
| Rate for Payer: Cigna of CA HMO |
$7.92
|
| Rate for Payer: Cigna of CA PPO |
$7.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.53
|
| Rate for Payer: Galaxy Health WC |
$9.62
|
| Rate for Payer: Global Benefits Group Commercial |
$6.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.49
|
| Rate for Payer: IEHP medi-cal |
$3.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.49
|
| Rate for Payer: Networks By Design Commercial |
$7.36
|
| Rate for Payer: Prime Health Services Commercial |
$9.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.79
|
| Rate for Payer: Riverside University Health MISP |
$4.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.66
|
| Rate for Payer: United Healthcare All Other HMO |
$5.66
|
| Rate for Payer: United Healthcare HMO Rider |
$5.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.62
|
| Rate for Payer: Vantage Medical Group Senior |
$9.62
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
OP
|
$0.82
|
|
|
Service Code
|
NDC 68084-365-01
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.62
|
| Rate for Payer: IEHP medi-cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: Riverside University Health MISP |
$0.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
IP
|
$0.76
|
|
|
Service Code
|
NDC 0832-0511-01
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Central Health Plan Commercial |
$0.61
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
IP
|
$0.82
|
|
|
Service Code
|
NDC 68084-365-01
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
OP
|
$0.82
|
|
|
Service Code
|
NDC 68084-365-11
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.62
|
| Rate for Payer: IEHP medi-cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: Riverside University Health MISP |
$0.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
IP
|
$0.38
|
|
|
Service Code
|
NDC 0832-0511-00
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
