|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 50268-411-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
NDC 51672-3007-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$12.19 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11.00
|
| 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 |
$12.19
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]
|
Facility
|
OP
|
$16.25
|
|
|
Service Code
|
NDC 51672-3007-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.81 |
| 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 |
$11.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.19
|
| Rate for Payer: Blue Shield of California Commercial |
$9.91
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.81
|
| Rate for Payer: Dignity Health Senior |
$13.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| 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 |
$7.75
|
| 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: Molina Healthcare of CA Medi-Cal |
$11.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.38
|
| Rate for Payer: Multiplan Commercial |
$12.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.50
|
| Rate for Payer: TriValley Medical Group Senior |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.81
|
| Rate for Payer: Vantage Medical Group Senior |
$13.81
|
|
|
HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0179-8016-30
|
| Hospital Charge Code |
901700029
|
|
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 |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| 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: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
HYDROCORTISONE-ALOE VERA 0.5 % TOPICAL CREAM [110413]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0179-8016-30
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.04
|
| 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 ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0802-81
|
| Hospital Charge Code |
901700029
|
|
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 |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.34
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| 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: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
HYDROCORTISONE ORAL SUSPENSION COMPOUND 2 MG/ML [4080281]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 9994-0802-81
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.34
|
| 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 SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
OP
|
$22.98
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$40.66 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.66
|
| Rate for Payer: Blue Shield of California Commercial |
$16.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.01
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.53
|
| Rate for Payer: Dignity Health Senior |
$19.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.64
|
| Rate for Payer: Heritage Provider Network Senior |
$10.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.09
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.19
|
| Rate for Payer: TriValley Medical Group Senior |
$9.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.53
|
| Rate for Payer: Vantage Medical Group Senior |
$19.53
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION [111163]
|
Facility
|
IP
|
$22.98
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.64
|
| Rate for Payer: Heritage Provider Network Senior |
$10.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$17.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.61
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [121171]
|
Facility
|
OP
|
$28.88
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$40.66 |
| Rate for Payer: Adventist Health Commercial |
$5.78
|
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.66
|
| Rate for Payer: Blue Shield of California Commercial |
$16.01
|
| Rate for Payer: Blue Shield of California Commercial |
$16.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.01
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.55
|
| Rate for Payer: Dignity Health Senior |
$24.10
|
| Rate for Payer: Dignity Health Senior |
$24.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.13
|
| Rate for Payer: Heritage Provider Network Senior |
$13.13
|
| Rate for Payer: Heritage Provider Network Senior |
$13.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.22
|
| Rate for Payer: Multiplan Commercial |
$21.66
|
| Rate for Payer: Multiplan Commercial |
$21.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.34
|
| Rate for Payer: TriValley Medical Group Senior |
$11.34
|
| Rate for Payer: TriValley Medical Group Senior |
$11.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.55
|
| Rate for Payer: Vantage Medical Group Senior |
$24.10
|
| Rate for Payer: Vantage Medical Group Senior |
$24.55
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [121171]
|
Facility
|
IP
|
$28.35
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$21.26 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Adventist Health Commercial |
$5.78
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.13
|
| Rate for Payer: Heritage Provider Network Senior |
$13.13
|
| Rate for Payer: Heritage Provider Network Senior |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.09
|
| Rate for Payer: Multiplan Commercial |
$21.66
|
| Rate for Payer: Multiplan Commercial |
$21.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.39
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
OP
|
$53.44
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$45.42 |
| Rate for Payer: Adventist Health Commercial |
$10.69
|
| Rate for Payer: Adventist Health Commercial |
$10.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.66
|
| Rate for Payer: Blue Shield of California Commercial |
$16.01
|
| Rate for Payer: Blue Shield of California Commercial |
$16.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.01
|
| Rate for Payer: Cash Price |
$29.39
|
| Rate for Payer: Cash Price |
$28.84
|
| Rate for Payer: Cash Price |
$28.84
|
| Rate for Payer: Cash Price |
$29.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.42
|
| Rate for Payer: Dignity Health Senior |
$44.57
|
| Rate for Payer: Dignity Health Senior |
$45.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.41
|
| Rate for Payer: Multiplan Commercial |
$40.08
|
| Rate for Payer: Multiplan Commercial |
$39.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.98
|
| Rate for Payer: TriValley Medical Group Senior |
$20.98
|
| Rate for Payer: TriValley Medical Group Senior |
$21.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.42
|
| Rate for Payer: Vantage Medical Group Senior |
$44.57
|
| Rate for Payer: Vantage Medical Group Senior |
$45.42
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [121170]
|
Facility
|
IP
|
$52.44
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Adventist Health Commercial |
$10.49
|
| Rate for Payer: Adventist Health Commercial |
$10.69
|
| Rate for Payer: Cash Price |
$29.39
|
| Rate for Payer: Cash Price |
$28.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.11
|
| Rate for Payer: Multiplan Commercial |
$40.08
|
| Rate for Payer: Multiplan Commercial |
$39.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.36
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
OP
|
$104.93
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$89.19 |
| Rate for Payer: Adventist Health Commercial |
$20.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.66
|
| Rate for Payer: Blue Shield of California Commercial |
$16.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.01
|
| Rate for Payer: Cash Price |
$57.71
|
| Rate for Payer: Cash Price |
$57.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.19
|
| Rate for Payer: Dignity Health Senior |
$89.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.58
|
| Rate for Payer: Heritage Provider Network Senior |
$48.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.45
|
| Rate for Payer: Multiplan Commercial |
$78.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.97
|
| Rate for Payer: TriValley Medical Group Senior |
$41.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.19
|
| Rate for Payer: Vantage Medical Group Senior |
$89.19
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION FOR INJECTION [121169]
|
Facility
|
IP
|
$104.93
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$78.70 |
| Rate for Payer: Adventist Health Commercial |
$20.99
|
| Rate for Payer: Cash Price |
$57.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.58
|
| Rate for Payer: Heritage Provider Network Senior |
$48.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.23
|
| Rate for Payer: Multiplan Commercial |
$78.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.74
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 51672-1292-1
|
| Hospital Charge Code |
901700029
|
|
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 |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.09
|
| 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 |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.41
|
| 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: United Healthcare All Other HMO/non HMO |
$3.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL OINTMENT [10219]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 51672-1292-1
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$3.46
|
| 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 |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION. [4082191]
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3.53
|
| Rate for Payer: Heritage Provider Network Senior |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.38
|
| 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: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.53
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION. [4082191]
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: Dignity Health Senior |
$6.49
|
| Rate for Payer: Dignity Health Senior |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3.53
|
| Rate for Payer: Heritage Provider Network Senior |
$4.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Senior |
$3.05
|
| Rate for Payer: TriValley Medical Group Senior |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.49
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION. [4081869]
|
Facility
|
IP
|
$4.98
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.65
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION. [4081869]
|
Facility
|
OP
|
$4.98
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.23
|
| Rate for Payer: Dignity Health Senior |
$4.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$3.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.99
|
| Rate for Payer: TriValley Medical Group Senior |
$1.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.23
|
| Rate for Payer: Vantage Medical Group Senior |
$4.23
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 9999-9102-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Senior |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Senior |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 0054-0386-63
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 42858-304-16
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.21
|
| 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
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID [10225]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 9999-9102-25
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Senior |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
|
