|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
IP
|
$362.90
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.68 |
| Max. Negotiated Rate |
$272.18 |
| Rate for Payer: Adventist Health Commercial |
$72.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.31
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$166.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.68
|
| Rate for Payer: Heritage Provider Network Senior |
$245.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$272.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$121.24
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION [32933]
|
Facility
OP
|
$362.90
|
|
|
Service Code
|
CPT J3285
|
| Hospital Charge Code |
NDG32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.38 |
| Max. Negotiated Rate |
$272.18 |
| Rate for Payer: Adventist Health Commercial |
$72.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.80
|
| Rate for Payer: Blue Shield of California Commercial |
$61.42
|
| Rate for Payer: Blue Shield of California EPN |
$61.42
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cash Price |
$163.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$166.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.02
|
| Rate for Payer: Dignity Health Senior |
$62.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$56.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.02
|
| Rate for Payer: Heritage Provider Network Senior |
$168.02
|
| Rate for Payer: Humana Medicare |
$56.38
|
| Rate for Payer: IEHP Medi-Cal |
$94.91
|
| Rate for Payer: IEHP Medicare Advantage |
$56.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$107.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.04
|
| Rate for Payer: Multiplan Commercial |
$272.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.02
|
| Rate for Payer: TriValley Medical Group Senior |
$56.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$121.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.02
|
| Rate for Payer: Vantage Medical Group Senior |
$56.38
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE [16005]
|
Facility
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
1711646
|
|
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: Aetna of CA Non-Gatekeeper |
$22.69
|
| Rate for Payer: Cash Price |
$14.86
|
| 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
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
1711646
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$30.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.50
|
| Rate for Payer: Blue Shield of California Commercial |
$21.95
|
| Rate for Payer: Blue Shield of California EPN |
$20.74
|
| Rate for Payer: Cash Price |
$15.90
|
| 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 |
$17.03
|
| 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
|
| 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
|
$35.34
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
1711646
|
|
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: Aetna of CA Non-Gatekeeper |
$24.28
|
| Rate for Payer: Cash Price |
$15.90
|
| 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
IP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
1711646
|
|
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: Aetna of CA Non-Gatekeeper |
$22.69
|
| Rate for Payer: Cash Price |
$14.86
|
| 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 |
1711646
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Blue Shield of California Commercial |
$20.51
|
| Rate for Payer: Blue Shield of California EPN |
$19.39
|
| Rate for Payer: Cash Price |
$14.86
|
| 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 |
$15.92
|
| 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
|
| 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
OP
|
$33.03
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
1711646
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$28.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.77
|
| Rate for Payer: Blue Shield of California Commercial |
$20.51
|
| Rate for Payer: Blue Shield of California EPN |
$19.39
|
| Rate for Payer: Cash Price |
$14.86
|
| 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 |
$15.92
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$28.08
|
|
|
TRIAMCINOLONE 9 MG-MOXIFLOX 0.6 MG/0.6 ML IN WATER(PF)INTRAOCULAR SUSP [221760]
|
Facility
OP
|
$30.60
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG221760
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$26.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.95
|
| Rate for Payer: Blue Shield of California Commercial |
$19.00
|
| Rate for Payer: Blue Shield of California EPN |
$17.96
|
| Rate for Payer: Cash Price |
$13.77
|
| 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 |
$14.75
|
| 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 |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.22
|
| 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
|
CPT J3490
|
| Hospital Charge Code |
NDG221760
|
|
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: Aetna of CA Non-Gatekeeper |
$21.02
|
| Rate for Payer: Cash Price |
$13.77
|
| 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 |
$20.72
|
| Rate for Payer: Heritage Provider Network Senior |
$20.72
|
| 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 |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.22
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 0168-0003-80
|
| Hospital Charge Code |
1743435
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare 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 |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| 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: Multiplan Commercial |
$0.11
|
| 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
|
$0.14
|
|
|
Service Code
|
NDC 0168-0003-80
|
| Hospital Charge Code |
1743435
|
|
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: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.06
|
| 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
|
$0.12
|
|
|
Service Code
|
NDC 45802-063-36
|
| Hospital Charge Code |
1743435
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare 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 |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| 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: Multiplan Commercial |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM [8112]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 45802-063-36
|
| Hospital Charge Code |
1743435
|
|
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 Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| 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
|
$0.09
|
|
|
Service Code
|
NDC 33342-327-80
|
| Hospital Charge Code |
1743435
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| 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: Multiplan Commercial |
$0.07
|
| 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
|
$0.09
|
|
|
Service Code
|
NDC 33342-327-80
|
| Hospital Charge Code |
1743435
|
|
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: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| 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 OINTMENT [8117]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
NDC 0713-0229-15
|
| Hospital Charge Code |
1743372
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| 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 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: Multiplan Commercial |
$0.19
|
| 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
OP
|
$0.40
|
|
|
Service Code
|
NDC 45802-054-35
|
| Hospital Charge Code |
1743372
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.18
|
| 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: Multiplan Commercial |
$0.30
|
| 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
|
$0.40
|
|
|
Service Code
|
NDC 45802-054-35
|
| Hospital Charge Code |
1743372
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| 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: Multiplan Commercial |
$0.30
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT [8117]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 0713-0229-80
|
| Hospital Charge Code |
1743370
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare 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 |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| 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: Multiplan Commercial |
$0.09
|
| 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
IP
|
$0.12
|
|
|
Service Code
|
NDC 0713-0229-80
|
| Hospital Charge Code |
1743370
|
|
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 Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| 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
IP
|
$0.25
|
|
|
Service Code
|
NDC 0713-0229-15
|
| Hospital Charge Code |
1743372
|
|
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 |
$0.17
|
| 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 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 0.1 % DENTAL PASTE [8121]
|
Facility
IP
|
$15.47
|
|
|
Service Code
|
NDC 51672-1267-5
|
| Hospital Charge Code |
1743376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: Adventist Health Commercial |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.63
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.47
|
| Rate for Payer: Heritage Provider Network Senior |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$11.60
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE [8121]
|
Facility
OP
|
$15.47
|
|
|
Service Code
|
NDC 51672-1267-5
|
| Hospital Charge Code |
1743376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$13.15 |
| Rate for Payer: Adventist Health Commercial |
$3.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.61
|
| Rate for Payer: Blue Shield of California EPN |
$9.08
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.15
|
| Rate for Payer: Dignity Health Senior |
$13.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.58
|
| Rate for Payer: Heritage Provider Network Senior |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$11.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.15
|
| Rate for Payer: Vantage Medical Group Senior |
$13.15
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE [8121]
|
Facility
OP
|
$15.47
|
|
|
Service Code
|
NDC 64980-320-05
|
| Hospital Charge Code |
1743376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$13.15 |
| Rate for Payer: Adventist Health Commercial |
$3.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.61
|
| Rate for Payer: Blue Shield of California EPN |
$9.08
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.15
|
| Rate for Payer: Dignity Health Senior |
$13.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.58
|
| Rate for Payer: Heritage Provider Network Senior |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$11.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.15
|
| Rate for Payer: Vantage Medical Group Senior |
$13.15
|
|
