|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP [91031]
|
Facility
|
IP
|
$11.49
|
|
|
Service Code
|
NDC 0186401001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Adventist Health Commercial |
$2.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.40
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.78
|
| Rate for Payer: Heritage Provider Network Senior |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$8.62
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$20,176.94
|
|
|
Service Code
|
MSDRG 391
|
| Min. Negotiated Rate |
$15,057.42 |
| Max. Negotiated Rate |
$20,176.94 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,057.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,057.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,316.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,176.94
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$12,672.72
|
|
|
Service Code
|
MSDRG 392
|
| Min. Negotiated Rate |
$9,457.25 |
| Max. Negotiated Rate |
$12,672.72 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,457.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,457.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,875.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,672.72
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,216.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,283.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1,283.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL WITH DIVERTICULECTOMY OF HYPOPHARYNX OR CERVICAL ESOPHAGUS (EG, ZENKER'S DIVERTICULUM), WITH CRICOPHARYNGEAL MYOTOMY, INCLUDES USE OF TELESCOPE OR OPERATING MICROSCOPE AND REPAIR, WHEN PERFORMED
|
Facility
|
OP
|
$14,466.39
|
|
|
Service Code
|
CPT 43180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$14,466.39 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,613.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9,365.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,466.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,755.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,375.28
|
| Rate for Payer: TriValley Medical Group Senior |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION OVER GUIDE WIRE
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 43196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,468.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,689.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,714.84
|
| Rate for Payer: TriValley Medical Group Senior |
$2,714.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 6157007401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2.75
|
| Rate for Payer: Blue Shield of California EPN |
$2.20
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$3.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.83
|
|
|
ESTERIFIED ESTROGENS 1.25 MG TABLET [9965]
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 6157007401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.90
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$3.38
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
OP
|
$3.07
|
|
|
Service Code
|
NDC 0093354143
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.23
|
| Rate for Payer: TriValley Medical Group Senior |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.61
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
OP
|
$9.74
|
|
|
Service Code
|
NDC 0430375414
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.87
|
| Rate for Payer: Blue Shield of California Commercial |
$5.94
|
| Rate for Payer: Blue Shield of California EPN |
$4.75
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.03
|
| Rate for Payer: Heritage Provider Network Senior |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.90
|
| Rate for Payer: TriValley Medical Group Senior |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.28
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
IP
|
$9.74
|
|
|
Service Code
|
NDC 0430375414
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$7.30 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.27
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM [9969]
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 0093354143
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.98
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
|
OP
|
$13.04
|
|
|
Service Code
|
NDC 0781712958
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California EPN |
$6.36
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.07
|
| Rate for Payer: Heritage Provider Network Senior |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
|
OP
|
$13.04
|
|
|
Service Code
|
NDC 0781712983
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California EPN |
$6.36
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.07
|
| Rate for Payer: Heritage Provider Network Senior |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
|
IP
|
$13.04
|
|
|
Service Code
|
NDC 0781712958
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.40
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.83
|
| Rate for Payer: Heritage Provider Network Senior |
$8.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27457]
|
Facility
|
IP
|
$13.04
|
|
|
Service Code
|
NDC 0781712983
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.40
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.83
|
| Rate for Payer: Heritage Provider Network Senior |
$8.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]
|
Facility
|
OP
|
$74.92
|
|
|
Service Code
|
NDC 5041949104
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$63.68 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.68
|
| Rate for Payer: Adventist Health Commercial |
$14.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.47
|
| Rate for Payer: Blue Shield of California Commercial |
$45.70
|
| Rate for Payer: Blue Shield of California EPN |
$36.56
|
| Rate for Payer: Cash Price |
$33.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.38
|
| Rate for Payer: Heritage Provider Network Senior |
$46.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$56.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.97
|
| Rate for Payer: TriValley Medical Group Senior |
$29.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.68
|
| Rate for Payer: Vantage Medical Group Senior |
$63.68
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH [37533]
|
Facility
|
IP
|
$74.92
|
|
|
Service Code
|
NDC 5041949104
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$56.19 |
| Rate for Payer: Adventist Health Commercial |
$14.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.25
|
| Rate for Payer: Cash Price |
$33.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.72
|
| Rate for Payer: Heritage Provider Network Senior |
$50.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.73
|
| Rate for Payer: Multiplan Commercial |
$56.19
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
NDC 0781714483
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California EPN |
$6.37
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.08
|
| Rate for Payer: Heritage Provider Network Senior |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.09
|
| Rate for Payer: Vantage Medical Group Senior |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
NDC 0781714458
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California EPN |
$6.37
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.08
|
| Rate for Payer: Heritage Provider Network Senior |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.09
|
| Rate for Payer: Vantage Medical Group Senior |
$11.09
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
NDC 0781714483
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.40
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.83
|
| Rate for Payer: Heritage Provider Network Senior |
$8.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Multiplan Commercial |
$9.79
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27459]
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
NDC 0781714458
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.40
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.83
|
| Rate for Payer: Heritage Provider Network Senior |
$8.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Multiplan Commercial |
$9.79
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0781713354
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$16.71 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.35
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.08
|
| Rate for Payer: Heritage Provider Network Senior |
$15.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0781713358
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$16.71 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.35
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.08
|
| Rate for Payer: Heritage Provider Network Senior |
$15.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0781713358
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.14
|
| Rate for Payer: Blue Shield of California Commercial |
$13.59
|
| Rate for Payer: Blue Shield of California EPN |
$10.87
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.79
|
| Rate for Payer: Heritage Provider Network Senior |
$13.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.91
|
| Rate for Payer: TriValley Medical Group Senior |
$8.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Vantage Medical Group Senior |
$18.94
|
|
