|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
IP
|
$1.30
|
|
|
Service Code
|
NDC 0168-0033-15
|
| Hospital Charge Code |
NDG1033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.88
|
| Rate for Payer: Heritage Provider Network Senior |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
OP
|
$1.30
|
|
|
Service Code
|
NDC 0168-0033-15
|
| Hospital Charge Code |
NDG1033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Senior |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT [1033]
|
Facility
IP
|
$1.30
|
|
|
Service Code
|
NDC 0472-0371-15
|
| Hospital Charge Code |
NDG1033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.88
|
| Rate for Payer: Heritage Provider Network Senior |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION [19703]
|
Facility
IP
|
$39.13
|
|
|
Service Code
|
NDC 0065-0246-10
|
| Hospital Charge Code |
NDG19703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$29.35 |
| Rate for Payer: Adventist Health Commercial |
$7.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.88
|
| Rate for Payer: Cash Price |
$17.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.49
|
| Rate for Payer: Heritage Provider Network Senior |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.78
|
| Rate for Payer: Multiplan Commercial |
$29.35
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION [19703]
|
Facility
OP
|
$39.13
|
|
|
Service Code
|
NDC 0065-0246-10
|
| Hospital Charge Code |
NDG19703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$33.26 |
| Rate for Payer: Adventist Health Commercial |
$7.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Blue Shield of California Commercial |
$24.30
|
| Rate for Payer: Blue Shield of California EPN |
$22.97
|
| Rate for Payer: Cash Price |
$17.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.26
|
| Rate for Payer: Dignity Health Senior |
$33.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.22
|
| Rate for Payer: Heritage Provider Network Senior |
$24.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.78
|
| Rate for Payer: Multiplan Commercial |
$29.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.26
|
| Rate for Payer: Vantage Medical Group Senior |
$33.26
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
IP
|
$12.18
|
|
|
Service Code
|
NDC 17478-705-10
|
| Hospital Charge Code |
1740210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.14 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.37
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.25
|
| Rate for Payer: Heritage Provider Network Senior |
$8.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.14
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
OP
|
$12.24
|
|
|
Service Code
|
NDC 61314-245-01
|
| Hospital Charge Code |
1740210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.18
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.40
|
| Rate for Payer: Dignity Health Senior |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.58
|
| Rate for Payer: Heritage Provider Network Senior |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10.40
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
IP
|
$11.32
|
|
|
Service Code
|
NDC 17478-705-11
|
| Hospital Charge Code |
1740211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$8.49 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.78
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.66
|
| Rate for Payer: Heritage Provider Network Senior |
$7.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$8.49
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
OP
|
$11.38
|
|
|
Service Code
|
NDC 61314-245-03
|
| Hospital Charge Code |
1740211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$7.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.68
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.67
|
| Rate for Payer: Dignity Health Senior |
$9.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.04
|
| Rate for Payer: Heritage Provider Network Senior |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.67
|
| Rate for Payer: Vantage Medical Group Senior |
$9.67
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
OP
|
$11.32
|
|
|
Service Code
|
NDC 17478-705-11
|
| Hospital Charge Code |
1740211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.49
|
| Rate for Payer: Blue Shield of California Commercial |
$7.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.64
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.62
|
| Rate for Payer: Dignity Health Senior |
$9.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.01
|
| Rate for Payer: Heritage Provider Network Senior |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$8.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.62
|
| Rate for Payer: Vantage Medical Group Senior |
$9.62
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
IP
|
$11.38
|
|
|
Service Code
|
NDC 61314-245-03
|
| Hospital Charge Code |
1740211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$8.54 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.82
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$8.54
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
OP
|
$12.18
|
|
|
Service Code
|
NDC 17478-705-10
|
| Hospital Charge Code |
1740210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$10.35 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7.56
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.35
|
| Rate for Payer: Dignity Health Senior |
$10.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.54
|
| Rate for Payer: Heritage Provider Network Senior |
$7.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.35
|
|
|
BETAXOLOL 0.5 % EYE DROPS [9268]
|
Facility
IP
|
$12.24
|
|
|
Service Code
|
NDC 61314-245-01
|
| Hospital Charge Code |
1740210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.41
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.29
|
| Rate for Payer: Heritage Provider Network Senior |
$8.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.06
|
| Rate for Payer: Multiplan Commercial |
$9.18
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
IP
|
$0.38
|
|
|
Service Code
|
NDC 0832-0511-00
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.26
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
OP
|
$0.76
|
|
|
Service Code
|
NDC 0832-0511-89
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Senior |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
IP
|
$0.76
|
|
|
Service Code
|
NDC 0832-0511-01
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.52
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
OP
|
$0.82
|
|
|
Service Code
|
NDC 68084-365-11
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.70
|
| Rate for Payer: Dignity Health Senior |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
IP
|
$0.82
|
|
|
Service Code
|
NDC 68084-365-01
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
OP
|
$0.38
|
|
|
Service Code
|
NDC 0832-0511-00
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: Dignity Health Senior |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
IP
|
$0.82
|
|
|
Service Code
|
NDC 68084-365-11
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
OP
|
$0.76
|
|
|
Service Code
|
NDC 0832-0511-01
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Senior |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
OP
|
$0.82
|
|
|
Service Code
|
NDC 68084-365-01
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.70
|
| Rate for Payer: Dignity Health Senior |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET [1043]
|
Facility
IP
|
$0.76
|
|
|
Service Code
|
NDC 0832-0511-89
|
| Hospital Charge Code |
1711218
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.52
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.57
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
IP
|
$0.55
|
|
|
Service Code
|
NDC 65162-573-10
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
|
|
BETHANECHOL CHLORIDE 25 MG TABLET [1044]
|
Facility
OP
|
$0.55
|
|
|
Service Code
|
NDC 65162-573-10
|
| Hospital Charge Code |
1711230
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Senior |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
