|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION [2331]
|
Facility
OP
|
$1.72
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1730171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Senior |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720136
|
|
Hospital Revenue Code
|
636
|
| 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 |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$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 Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
OP
|
$0.93
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.94
|
| Rate for Payer: Dignity Health Senior |
$2.94
|
| Rate for Payer: Dignity Health Senior |
$0.99
|
| Rate for Payer: Dignity Health Senior |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1.60
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.79
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$2.94
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [2332]
|
Facility
IP
|
$3.46
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
1720127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Senior |
$0.79
|
| Rate for Payer: Heritage Provider Network Senior |
$0.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.16
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SYRINGE [114048]
|
Facility
OP
|
$3.47
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG114048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.95
|
| Rate for Payer: Dignity Health Senior |
$2.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1.61
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2.95
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SYRINGE [114048]
|
Facility
IP
|
$3.47
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG114048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.38
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.35
|
| Rate for Payer: Heritage Provider Network Senior |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.16
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [118427]
|
Facility
IP
|
$2.10
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG118427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.44
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1.42
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$4.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.76
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [118427]
|
Facility
OP
|
$6.29
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG118427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Senior |
$1.78
|
| Rate for Payer: Dignity Health Senior |
$7.65
|
| Rate for Payer: Dignity Health Senior |
$4.49
|
| Rate for Payer: Dignity Health Senior |
$5.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$4.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.91
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE [225593]
|
Facility
IP
|
$6.94
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG225593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.77
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.32
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE [225593]
|
Facility
OP
|
$6.94
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
NDG225593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.90
|
| Rate for Payer: Dignity Health Senior |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.21
|
| Rate for Payer: Heritage Provider Network Senior |
$3.21
|
| Rate for Payer: IEHP Medi-Cal |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$5.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5.90
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
OP
|
$3.25
|
|
|
Service Code
|
NDC 70860-605-03
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.91
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.76
|
| Rate for Payer: Dignity Health Senior |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.76
|
| Rate for Payer: Vantage Medical Group Senior |
$2.76
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$3.25
|
|
|
Service Code
|
NDC 70860-605-41
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$4.32
|
|
|
Service Code
|
NDC 55150-209-02
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.97
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
OP
|
$4.32
|
|
|
Service Code
|
NDC 55150-209-02
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2.68
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$7.80
|
|
|
Service Code
|
NDC 0143-9532-25
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.36
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Senior |
$5.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$5.85
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
OP
|
$3.25
|
|
|
Service Code
|
NDC 42023-146-25
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.91
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.76
|
| Rate for Payer: Dignity Health Senior |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.76
|
| Rate for Payer: Vantage Medical Group Senior |
$2.76
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$3.25
|
|
|
Service Code
|
NDC 42023-146-25
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$3.25
|
|
|
Service Code
|
NDC 70860-605-03
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
OP
|
$7.80
|
|
|
Service Code
|
NDC 0143-9532-01
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.85
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$4.58
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Senior |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.83
|
| Rate for Payer: Heritage Provider Network Senior |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
OP
|
$3.25
|
|
|
Service Code
|
NDC 70860-605-41
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.91
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.76
|
| Rate for Payer: Dignity Health Senior |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.76
|
| Rate for Payer: Vantage Medical Group Senior |
$2.76
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$3.24
|
|
|
Service Code
|
NDC 71288-505-02
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.19
|
| Rate for Payer: Heritage Provider Network Senior |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
OP
|
$3.24
|
|
|
Service Code
|
NDC 71288-505-02
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.90
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.75
|
| Rate for Payer: Dignity Health Senior |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2.75
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$7.80
|
|
|
Service Code
|
NDC 0143-9532-01
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.36
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Senior |
$5.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$5.85
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [27103]
|
Facility
IP
|
$3.24
|
|
|
Service Code
|
NDC 71288-505-03
|
| Hospital Charge Code |
1759932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.19
|
| Rate for Payer: Heritage Provider Network Senior |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
|
