|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
IP
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: Adventist Health Commercial |
$7.07
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.93
|
| Rate for Payer: Heritage Provider Network Senior |
$23.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.84
|
| Rate for Payer: Multiplan Commercial |
$26.50
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Adventist Health Commercial |
$7.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.50
|
| Rate for Payer: Blue Shield of California Commercial |
$21.56
|
| Rate for Payer: Blue Shield of California EPN |
$17.25
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.04
|
| Rate for Payer: Dignity Health Senior |
$30.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.88
|
| Rate for Payer: Heritage Provider Network Senior |
$21.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.74
|
| Rate for Payer: Multiplan Commercial |
$26.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.14
|
| Rate for Payer: TriValley Medical Group Senior |
$14.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.04
|
| Rate for Payer: Vantage Medical Group Senior |
$30.04
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.36
|
| Rate for Payer: Heritage Provider Network Senior |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.26
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$16.12
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Senior |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.45
|
| Rate for Payer: Heritage Provider Network Senior |
$20.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.21
|
| Rate for Payer: TriValley Medical Group Senior |
$13.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.36
|
| Rate for Payer: Heritage Provider Network Senior |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.26
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$16.12
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Senior |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.45
|
| Rate for Payer: Heritage Provider Network Senior |
$20.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.21
|
| Rate for Payer: TriValley Medical Group Senior |
$13.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN MICROSPHERES 0.1 % TOPICAL GEL [19468]
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 0187-5140-45
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Blue Shield of California Commercial |
$12.81
|
| Rate for Payer: Blue Shield of California EPN |
$10.25
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.85
|
| Rate for Payer: Dignity Health Senior |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.85
|
| Rate for Payer: Vantage Medical Group Senior |
$17.85
|
|
|
TRETINOIN MICROSPHERES 0.1 % TOPICAL GEL [19468]
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 0187-5140-45
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.22
|
| Rate for Payer: Heritage Provider Network Senior |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
|
|
TRETINOIN (VESANOID) ORAL SYRINGE [40820212]
|
Facility
|
OP
|
$33.03
|
|
|
Service Code
|
NDC 9940-8202-12
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$28.08 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Blue Shield of California EPN |
$16.12
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Senior |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.45
|
| Rate for Payer: Heritage Provider Network Senior |
$20.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRETINOIN (VESANOID) ORAL SYRINGE [40820212]
|
Facility
|
IP
|
$33.03
|
|
|
Service Code
|
NDC 9940-8202-12
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Adventist Health Commercial |
$6.61
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.36
|
| Rate for Payer: Heritage Provider Network Senior |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.26
|
| Rate for Payer: Multiplan Commercial |
$24.77
|
|
|
TRIAMCINOLONE 9 MG-MOXIFLOX 0.6 MG/0.6 ML IN WATER(PF)INTRAOCULAR SUSP [221760]
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Adventist Health Commercial |
$6.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.95
|
| Rate for Payer: Blue Shield of California Commercial |
$18.67
|
| Rate for Payer: Blue Shield of California EPN |
$14.93
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.01
|
| Rate for Payer: Dignity Health Senior |
$26.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.17
|
| Rate for Payer: Heritage Provider Network Senior |
$14.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$22.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.24
|
| Rate for Payer: TriValley Medical Group Senior |
$12.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.01
|
| Rate for Payer: Vantage Medical Group Senior |
$26.01
|
|
|
TRIAMCINOLONE 9 MG-MOXIFLOX 0.6 MG/0.6 ML IN WATER(PF)INTRAOCULAR SUSP [221760]
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Adventist Health Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.17
|
| Rate for Payer: Heritage Provider Network Senior |
$14.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$22.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.13
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 33342-327-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0168-0003-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0168-0003-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Senior |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0713-0226-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0713-0226-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 33342-327-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Senior |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 45802-063-36
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 45802-063-36
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT [8117]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 45802-054-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Senior |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT [8117]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 0713-0229-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT [8117]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0713-0229-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Senior |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT [8117]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0713-0229-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT [8117]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0713-0229-80
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
