|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM [8114]
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 4580206535
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL OINTMENT [8119]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 4580204935
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL OINTMENT [8119]
|
Facility
|
IP
|
$0.65
|
|
|
Service Code
|
NDC 4580204935
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.42
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [11584]
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Senior |
$1.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.46
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [11584]
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.87
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.89
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML MED NEB SOLUTION [4080950]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 0003029320
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.70
|
| Rate for Payer: Blue Shield of California Commercial |
$6.95
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.06
|
| Rate for Payer: Heritage Provider Network Senior |
$7.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.56
|
| Rate for Payer: TriValley Medical Group Senior |
$4.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML MED NEB SOLUTION [4080950]
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
NDC 0003029320
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.34
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.72
|
| Rate for Payer: Heritage Provider Network Senior |
$7.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.85
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML MED NEB SOLUTION [4080950]
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
NDC 0003029305
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6.85
|
| Rate for Payer: Blue Shield of California EPN |
$5.48
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.49
|
| Rate for Payer: TriValley Medical Group Senior |
$4.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML MED NEB SOLUTION [4080950]
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
NDC 0003029305
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.23
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.81
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.72
|
| Rate for Payer: Heritage Provider Network Senior |
$4.82
|
| Rate for Payer: Heritage Provider Network Senior |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.16
|
| Rate for Payer: TriValley Medical Group Senior |
$4.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Vantage Medical Group Senior |
$8.84
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.70
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.82
|
| Rate for Payer: Heritage Provider Network Senior |
$4.82
|
| Rate for Payer: Heritage Provider Network Senior |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$7.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.38
|
|
|
TRIAMCINOLONE ACETONIDE 55 MCG NASAL SPRAY AEROSOL [19808]
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
NDC 4116758003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Senior |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Vantage Medical Group Senior |
$1.14
|
|
|
TRIAMCINOLONE ACETONIDE 55 MCG NASAL SPRAY AEROSOL [19808]
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
NDC 4116758003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.86
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Senior |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML INTRAOCULAR SUSPENSION [89128]
|
Facility
|
OP
|
$778.80
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Adventist Health Commercial |
$155.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$481.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.86
|
| Rate for Payer: Blue Shield of California Commercial |
$24.07
|
| Rate for Payer: Blue Shield of California EPN |
$24.07
|
| Rate for Payer: Cash Price |
$350.46
|
| Rate for Payer: Cash Price |
$350.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$358.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.58
|
| Rate for Payer: Heritage Provider Network Senior |
$360.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$371.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.71
|
| Rate for Payer: Multiplan Commercial |
$584.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$311.52
|
| Rate for Payer: TriValley Medical Group Senior |
$311.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$281.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$257.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.11
|
| Rate for Payer: Vantage Medical Group Senior |
$21.11
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML INTRAOCULAR SUSPENSION [89128]
|
Facility
|
IP
|
$778.80
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.96 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Adventist Health Commercial |
$155.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.55
|
| Rate for Payer: Cash Price |
$350.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$358.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.58
|
| Rate for Payer: Heritage Provider Network Senior |
$360.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.70
|
| Rate for Payer: Multiplan Commercial |
$584.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$281.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$257.86
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML SUPRACHOROIDAL SUSPENSION [235246]
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS J3299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$398.20 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,018.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,018.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$794.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$728.42
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML SUPRACHOROIDAL SUSPENSION [235246]
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS J3299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,359.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.09
|
| Rate for Payer: Blue Shield of California Commercial |
$46.75
|
| Rate for Payer: Blue Shield of California EPN |
$46.75
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,018.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,018.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,049.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.01
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$880.00
|
| Rate for Payer: TriValley Medical Group Senior |
$880.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$794.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$728.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.55
|
| Rate for Payer: Vantage Medical Group Senior |
$52.55
|
|
|
TRIAMCINOLONE MOXIFLOXACIN VANCOMYCIN (TRI-MOXI-VANC) OPHTHALMIC INJECTION [4081389]
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Blue Shield of California Commercial |
$15.25
|
| Rate for Payer: Blue Shield of California EPN |
$12.20
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.57
|
| Rate for Payer: Heritage Provider Network Senior |
$11.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.00
|
| Rate for Payer: TriValley Medical Group Senior |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
TRIAMCINOLONE MOXIFLOXACIN VANCOMYCIN (TRI-MOXI-VANC) OPHTHALMIC INJECTION [4081389]
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.57
|
| Rate for Payer: Heritage Provider Network Senior |
$11.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.28
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 0527163201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 0781207410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| 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 |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| 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 |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 0781207401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| 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 |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 0781207401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 7257809001
|
| 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 Non-Gatekeeper |
$0.15
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| 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 |
$0.11
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 7257809001
|
| 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: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| 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 Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
