|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH [110634]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0781713354
|
| 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
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
NDC 6516222804
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.79
|
| Rate for Payer: Blue Shield of California Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California EPN |
$9.55
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.11
|
| Rate for Payer: Heritage Provider Network Senior |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.83
|
| Rate for Payer: TriValley Medical Group Senior |
$7.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 6516222808
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$14.68 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.60
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Heritage Provider Network Senior |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
NDC 6516222808
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.79
|
| Rate for Payer: Blue Shield of California Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California EPN |
$9.55
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.11
|
| Rate for Payer: Heritage Provider Network Senior |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.83
|
| Rate for Payer: TriValley Medical Group Senior |
$7.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.63
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH [27461]
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
NDC 6516222804
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$14.68 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.60
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Heritage Provider Network Senior |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0378335299
|
| 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 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 0378335216
|
| 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 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0378335299
|
| 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
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH [112051]
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 0378335216
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.77
|
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| 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
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 5186233201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 5186233201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 4280608701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 7095456410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: 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 Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 4280608701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: 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 Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
ESTRADIOL 0.5 MG TABLET [12491]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 7095456410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
ESTRADIOL 1 MG TABLET [9967]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 4280608801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| 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 Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
ESTRADIOL 1 MG TABLET [9967]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 4280608801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 4280608901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 4280608901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| 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 Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 7095456610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| 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 Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 5186233401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.31
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Senior |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 5186233401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 0555088702
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 7095456610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
ESTRADIOL 2 MG TABLET [9968]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 0555088702
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.31
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Senior |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
|
