|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL OINTMENT [70383]
|
Facility
IP
|
$23.78
|
|
|
Service Code
|
NDC 50222-227-04
|
| Hospital Charge Code |
1743778
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$17.84
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Central Health Plan Commercial |
$19.02
|
| Rate for Payer: Cigna of CA HMO |
$16.65
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.51
|
| Rate for Payer: Galaxy Health WC |
$20.21
|
| Rate for Payer: Global Benefits Group Commercial |
$14.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$15.46
|
| Rate for Payer: Prime Health Services Commercial |
$20.21
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL OINTMENT [70383]
|
Facility
OP
|
$23.78
|
|
|
Service Code
|
NDC 50222-227-04
|
| Hospital Charge Code |
1743778
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$21.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.05
|
| Rate for Payer: BCBS Transplant Transplant |
$14.27
|
| Rate for Payer: Blue Shield of California Commercial |
$14.96
|
| Rate for Payer: Blue Shield of California EPN |
$11.63
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Central Health Plan Commercial |
$19.02
|
| Rate for Payer: Cigna of CA HMO |
$16.65
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.51
|
| Rate for Payer: Galaxy Health WC |
$20.21
|
| Rate for Payer: Global Benefits Group Commercial |
$14.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.84
|
| Rate for Payer: IEHP medi-cal |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$15.46
|
| Rate for Payer: Prime Health Services Commercial |
$20.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.27
|
| Rate for Payer: Riverside University Health MISP |
$9.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.89
|
| Rate for Payer: United Healthcare All Other HMO |
$11.89
|
| Rate for Payer: United Healthcare HMO Rider |
$11.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$20.21
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL OINTMENT [70383]
|
Facility
IP
|
$19.82
|
|
|
Service Code
|
NDC 50222-227-81
|
| Hospital Charge Code |
NDG70383
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.86
|
| Rate for Payer: Blue Shield of California EPN |
$10.58
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Central Health Plan Commercial |
$15.86
|
| Rate for Payer: Cigna of CA HMO |
$13.87
|
| Rate for Payer: Cigna of CA PPO |
$13.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.93
|
| Rate for Payer: Galaxy Health WC |
$16.85
|
| Rate for Payer: Global Benefits Group Commercial |
$11.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$16.85
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL SUSPENSION [91914]
|
Facility
IP
|
$25.28
|
|
|
Service Code
|
NDC 50222-501-06
|
| Hospital Charge Code |
NDG91914
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$18.96
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Central Health Plan Commercial |
$20.22
|
| Rate for Payer: Cigna of CA HMO |
$17.70
|
| Rate for Payer: Cigna of CA PPO |
$17.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.11
|
| Rate for Payer: Galaxy Health WC |
$21.49
|
| Rate for Payer: Global Benefits Group Commercial |
$15.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.06
|
| Rate for Payer: Multiplan Commercial |
$18.96
|
| Rate for Payer: Networks By Design Commercial |
$16.43
|
| Rate for Payer: Prime Health Services Commercial |
$21.49
|
|
|
CALCIPOTRIENE-BETAMETHASONE 0.005 %-0.064 % TOPICAL SUSPENSION [91914]
|
Facility
OP
|
$25.28
|
|
|
Service Code
|
NDC 50222-501-06
|
| Hospital Charge Code |
NDG91914
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.94
|
| Rate for Payer: BCBS Transplant Transplant |
$15.17
|
| Rate for Payer: Blue Shield of California Commercial |
$15.90
|
| Rate for Payer: Blue Shield of California EPN |
$12.36
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Central Health Plan Commercial |
$20.22
|
| Rate for Payer: Cigna of CA HMO |
$17.70
|
| Rate for Payer: Cigna of CA PPO |
$17.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.11
|
| Rate for Payer: Galaxy Health WC |
$21.49
|
| Rate for Payer: Global Benefits Group Commercial |
$15.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.96
|
| Rate for Payer: IEHP medi-cal |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.06
|
| Rate for Payer: Multiplan Commercial |
$18.96
|
| Rate for Payer: Networks By Design Commercial |
$16.43
|
| Rate for Payer: Prime Health Services Commercial |
$21.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.17
|
| Rate for Payer: Riverside University Health MISP |
$10.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.64
|
| Rate for Payer: United Healthcare All Other HMO |
$12.64
|
| Rate for Payer: United Healthcare HMO Rider |
$12.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.49
|
| Rate for Payer: Vantage Medical Group Senior |
$21.49
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]
|
Facility
OP
|
$24.28
|
|
|
Service Code
|
NDC 60505-0823-6
|
| Hospital Charge Code |
1744077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.34
|
| Rate for Payer: BCBS Transplant Transplant |
$14.57
|
| Rate for Payer: Blue Shield of California Commercial |
$15.27
|
| Rate for Payer: Blue Shield of California EPN |
$11.87
|
| Rate for Payer: Cash Price |
$10.93
|
| Rate for Payer: Central Health Plan Commercial |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$17.00
|
| Rate for Payer: Cigna of CA PPO |
$17.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.64
|
| Rate for Payer: Global Benefits Group Commercial |
$14.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.21
|
| Rate for Payer: IEHP medi-cal |
$8.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$18.21
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.57
|
| Rate for Payer: Riverside University Health MISP |
$9.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.64
|
| Rate for Payer: Vantage Medical Group Senior |
$20.64
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY [15738]
|
Facility
IP
|
$24.28
|
|
|
Service Code
|
NDC 60505-0823-6
|
| Hospital Charge Code |
1744077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$12.97
|
| Rate for Payer: Cash Price |
$10.93
|
| Rate for Payer: Cash Price |
$10.93
|
| Rate for Payer: Central Health Plan Commercial |
$19.42
|
| Rate for Payer: Cigna of CA HMO |
$17.00
|
| Rate for Payer: Cigna of CA PPO |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.64
|
| Rate for Payer: Global Benefits Group Commercial |
$14.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$18.21
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.64
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]
|
Facility
OP
|
$1,879.26
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
1720101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$6,627.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,069.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,069.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,627.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,627.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,336.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,336.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,176.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,176.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1,127.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1,127.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,799.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3,799.97
|
| Rate for Payer: Blue Shield of California EPN |
$3,454.52
|
| Rate for Payer: Blue Shield of California EPN |
$3,454.52
|
| Rate for Payer: Caremore Medicare Advantage |
$1,069.50
|
| Rate for Payer: Caremore Medicare Advantage |
$1,069.50
|
| Rate for Payer: Cash Price |
$845.37
|
| Rate for Payer: Cash Price |
$845.37
|
| Rate for Payer: Cash Price |
$845.67
|
| Rate for Payer: Cash Price |
$845.67
|
| Rate for Payer: Central Health Plan Commercial |
$1,502.88
|
| Rate for Payer: Central Health Plan Commercial |
$1,503.41
|
| Rate for Payer: Cigna of CA HMO |
$1,315.02
|
| Rate for Payer: Cigna of CA HMO |
$1,315.48
|
| Rate for Payer: Cigna of CA PPO |
$1,315.48
|
| Rate for Payer: Cigna of CA PPO |
$1,315.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,604.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,604.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,443.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,443.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,069.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,069.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,069.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,069.50
|
| Rate for Payer: Galaxy Health WC |
$1,597.37
|
| Rate for Payer: Galaxy Health WC |
$1,596.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,691.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,690.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,409.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,408.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,753.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,753.98
|
| Rate for Payer: IEHP medi-cal |
$1,764.67
|
| Rate for Payer: IEHP medi-cal |
$1,764.67
|
| Rate for Payer: IEHP Medicare Advantage |
$1,069.50
|
| Rate for Payer: IEHP Medicare Advantage |
$1,069.50
|
| Rate for Payer: Innovage PACE Commercial |
$1,604.25
|
| Rate for Payer: Innovage PACE Commercial |
$1,604.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,069.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,069.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,433.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,433.13
|
| Rate for Payer: Multiplan Commercial |
$1,408.95
|
| Rate for Payer: Multiplan Commercial |
$1,409.44
|
| Rate for Payer: Networks By Design Commercial |
$939.30
|
| Rate for Payer: Networks By Design Commercial |
$939.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,597.37
|
| Rate for Payer: Prime Health Services Commercial |
$1,596.81
|
| Rate for Payer: Prime Health Services Medicare |
$1,133.67
|
| Rate for Payer: Prime Health Services Medicare |
$1,133.67
|
| Rate for Payer: Riverside University Health MISP |
$1,176.45
|
| Rate for Payer: Riverside University Health MISP |
$1,176.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,127.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,127.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,127.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,127.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.63
|
| Rate for Payer: United Healthcare All Other HMO |
$939.63
|
| Rate for Payer: United Healthcare All Other HMO |
$939.30
|
| Rate for Payer: United Healthcare HMO Rider |
$939.63
|
| Rate for Payer: United Healthcare HMO Rider |
$939.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$939.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$939.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,604.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,604.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,069.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,069.50
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION [9347]
|
Facility
IP
|
$1,878.60
|
|
|
Service Code
|
CPT J0630
|
| Hospital Charge Code |
1720101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$375.72 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,409.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,408.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,003.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,003.52
|
| Rate for Payer: Cash Price |
$845.67
|
| Rate for Payer: Cash Price |
$845.37
|
| Rate for Payer: Cash Price |
$845.37
|
| Rate for Payer: Cash Price |
$845.67
|
| Rate for Payer: Central Health Plan Commercial |
$1,503.41
|
| Rate for Payer: Central Health Plan Commercial |
$1,502.88
|
| Rate for Payer: Cigna of CA HMO |
$1,315.48
|
| Rate for Payer: Cigna of CA HMO |
$1,315.02
|
| Rate for Payer: Cigna of CA PPO |
$1,315.02
|
| Rate for Payer: Cigna of CA PPO |
$1,315.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$751.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$751.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$751.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$751.44
|
| Rate for Payer: Galaxy Health WC |
$1,597.37
|
| Rate for Payer: Galaxy Health WC |
$1,596.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,691.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,690.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.85
|
| Rate for Payer: Multiplan Commercial |
$1,409.44
|
| Rate for Payer: Multiplan Commercial |
$1,408.95
|
| Rate for Payer: Networks By Design Commercial |
$939.30
|
| Rate for Payer: Networks By Design Commercial |
$939.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,597.37
|
| Rate for Payer: Prime Health Services Commercial |
$1,596.81
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
IP
|
$0.89
|
|
|
Service Code
|
NDC 60687-345-11
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.40
|
| 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
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
OP
|
$0.33
|
|
|
Service Code
|
NDC 69452-207-13
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
IP
|
$0.89
|
|
|
Service Code
|
NDC 60687-345-01
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.40
|
| 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
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
IP
|
$1.14
|
|
|
Service Code
|
NDC 0054-0007-25
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Central Health Plan Commercial |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
OP
|
$1.14
|
|
|
Service Code
|
NDC 0054-0007-25
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: BCBS Transplant Transplant |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Central Health Plan Commercial |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.86
|
| Rate for Payer: IEHP medi-cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.74
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.68
|
| Rate for Payer: Riverside University Health MISP |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Vantage Medical Group Senior |
$0.97
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
IP
|
$0.33
|
|
|
Service Code
|
NDC 69452-207-20
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
OP
|
$0.89
|
|
|
Service Code
|
NDC 60687-345-01
|
| Hospital Charge Code |
1710534
|
|
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
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
IP
|
$0.33
|
|
|
Service Code
|
NDC 69452-207-13
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
OP
|
$0.33
|
|
|
Service Code
|
NDC 69452-207-20
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
IP
|
$0.33
|
|
|
Service Code
|
NDC 64380-723-04
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
IP
|
$0.33
|
|
|
Service Code
|
NDC 62756-967-88
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
OP
|
$0.33
|
|
|
Service Code
|
NDC 62756-967-88
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
OP
|
$0.33
|
|
|
Service Code
|
NDC 64380-723-04
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
OP
|
$0.89
|
|
|
Service Code
|
NDC 60687-345-11
|
| Hospital Charge Code |
1710534
|
|
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
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
IP
|
$0.33
|
|
|
Service Code
|
NDC 64380-723-06
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
CALCITRIOL 0.25 MCG CAPSULE [9350]
|
Facility
OP
|
$0.33
|
|
|
Service Code
|
NDC 64380-723-06
|
| Hospital Charge Code |
1710534
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
