|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
|
OP
|
$14.17
|
|
|
Service Code
|
NDC 42494-341-12
|
| Hospital Charge Code |
1748041
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.63
|
| Rate for Payer: Blue Shield of California Commercial |
$8.80
|
| Rate for Payer: Blue Shield of California EPN |
$8.32
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.04
|
| Rate for Payer: Dignity Health Senior |
$12.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.77
|
| Rate for Payer: Heritage Provider Network Senior |
$8.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$10.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.67
|
| Rate for Payer: TriValley Medical Group Senior |
$5.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.04
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
|
IP
|
$14.17
|
|
|
Service Code
|
NDC 42494-341-12
|
| Hospital Charge Code |
1748041
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.73
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.59
|
| Rate for Payer: Heritage Provider Network Senior |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$10.63
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
NDC 51672-3007-1
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.17
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
NDC 51672-3007-1
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.10
|
| Rate for Payer: Blue Shield of California EPN |
$9.54
|
| Rate for Payer: Cash Price |
$7.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.82
|
| Rate for Payer: Dignity Health Senior |
$13.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.06
|
| Rate for Payer: Heritage Provider Network Senior |
$10.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.50
|
| Rate for Payer: TriValley Medical Group Senior |
$6.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.82
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
IP
|
$19.33
|
|
|
Service Code
|
NDC 50383-901-10
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.28
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.09
|
| Rate for Payer: Heritage Provider Network Senior |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.83
|
| Rate for Payer: Multiplan Commercial |
$14.50
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
OP
|
$19.33
|
|
|
Service Code
|
NDC 50383-901-10
|
| Hospital Charge Code |
1740196
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$16.43 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.50
|
| Rate for Payer: Blue Shield of California Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California EPN |
$11.35
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.43
|
| Rate for Payer: Dignity Health Senior |
$16.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.97
|
| Rate for Payer: Heritage Provider Network Senior |
$11.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.83
|
| Rate for Payer: Multiplan Commercial |
$14.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.73
|
| Rate for Payer: TriValley Medical Group Senior |
$7.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.43
|
| Rate for Payer: Vantage Medical Group Senior |
$16.43
|
|
|
HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0179-8016-30
|
| Hospital Charge Code |
NDG110413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0179-8016-30
|
| Hospital Charge Code |
NDG110413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Senior |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
HYDROCORTISONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0802-81
|
| Hospital Charge Code |
1715652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
|
|
HYDROCORTISONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0802-81
|
| Hospital Charge Code |
1715652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Senior |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Senior |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
IP
|
$17.26
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
ERX111163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$12.94 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.86
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.69
|
| Rate for Payer: Heritage Provider Network Senior |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.77
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
OP
|
$17.26
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
ERX111163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$13.97
|
| Rate for Payer: Blue Shield of California EPN |
$13.97
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.67
|
| Rate for Payer: Dignity Health Senior |
$14.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.99
|
| Rate for Payer: Heritage Provider Network Senior |
$7.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.90
|
| Rate for Payer: TriValley Medical Group Senior |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.67
|
| Rate for Payer: Vantage Medical Group Senior |
$14.67
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
OP
|
$43.14
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
1720335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$13.97
|
| Rate for Payer: Blue Shield of California EPN |
$13.97
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.67
|
| Rate for Payer: Dignity Health Senior |
$36.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.97
|
| Rate for Payer: Heritage Provider Network Senior |
$19.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.78
|
| Rate for Payer: Multiplan Commercial |
$32.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.26
|
| Rate for Payer: TriValley Medical Group Senior |
$17.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.67
|
| Rate for Payer: Vantage Medical Group Senior |
$36.67
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
IP
|
$43.14
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
1720335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$32.36 |
| Rate for Payer: Adventist Health Commercial |
$8.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.64
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.21
|
| Rate for Payer: Heritage Provider Network Senior |
$29.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.78
|
| Rate for Payer: Multiplan Commercial |
$32.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.41
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
OP
|
$86.32
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
ERX121169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$73.37 |
| Rate for Payer: Adventist Health Commercial |
$17.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$13.97
|
| Rate for Payer: Blue Shield of California EPN |
$13.97
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.37
|
| Rate for Payer: Dignity Health Senior |
$73.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.97
|
| Rate for Payer: Heritage Provider Network Senior |
$39.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.58
|
| Rate for Payer: Multiplan Commercial |
$64.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.53
|
| Rate for Payer: TriValley Medical Group Senior |
$34.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.37
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
IP
|
$86.32
|
|
|
Service Code
|
CPT J1720
|
| Hospital Charge Code |
ERX121169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$64.74 |
| Rate for Payer: Adventist Health Commercial |
$17.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.30
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.44
|
| Rate for Payer: Heritage Provider Network Senior |
$58.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.58
|
| Rate for Payer: Multiplan Commercial |
$64.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.84
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL CREAM [10218]
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
NDC 45802-455-42
|
| Hospital Charge Code |
1743278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.64
|
| Rate for Payer: Dignity Health Senior |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1.64
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL CREAM [10218]
|
Facility
|
IP
|
$1.93
|
|
|
Service Code
|
NDC 45802-455-42
|
| Hospital Charge Code |
1743278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.33
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 51672-1292-1
|
| Hospital Charge Code |
NDG10219
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 51672-1292-1
|
| Hospital Charge Code |
NDG10219
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$3.70
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Senior |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Senior |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION. [4082191]
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
NDG202191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: Dignity Health Senior |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Senior |
$4.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.98
|
| Rate for Payer: TriValley Medical Group Senior |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION. [4082191]
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
NDG202191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.84
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Senior |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.33
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE [202191]
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
NDG202191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.04
|
| Rate for Payer: Dignity Health Senior |
$7.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.83
|
| Rate for Payer: Heritage Provider Network Senior |
$3.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.31
|
| Rate for Payer: TriValley Medical Group Senior |
$3.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.04
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE [202191]
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
NDG202191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.69
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.61
|
| Rate for Payer: Heritage Provider Network Senior |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.77
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SOLUTION [216053]
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
CPT J1170
|
| Hospital Charge Code |
1734065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.76
|
| Rate for Payer: Dignity Health Senior |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Senior |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.76
|
| Rate for Payer: Vantage Medical Group Senior |
$2.76
|
|
