HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]
|
Facility
OP
|
$0.16
|
|
Service Code
|
NDC 45802-004-03
|
Hospital Charge Code |
1743657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
Rate for Payer: Blue Shield of California Commercial |
$0.10
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: Dignity Health Senior |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Senior |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.12
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]
|
Facility
IP
|
$0.16
|
|
Service Code
|
NDC 45802-004-03
|
Hospital Charge Code |
1743657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.12 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Senior |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.12
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]
|
Facility
IP
|
$0.12
|
|
Service Code
|
NDC 51672-3003-2
|
Hospital Charge Code |
1743657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
Rate for Payer: Heritage Provider Network Senior |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.09
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]
|
Facility
OP
|
$0.13
|
|
Service Code
|
NDC 0168-0080-31
|
Hospital Charge Code |
1743657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.11 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.11
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.08
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.06
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
Rate for Payer: Dignity Health Senior |
$0.11
|
Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
Rate for Payer: Heritage Provider Network Senior |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.10
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]
|
Facility
OP
|
$0.12
|
|
Service Code
|
NDC 51672-3003-2
|
Hospital Charge Code |
1743657
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.10 |
Rate for Payer: Adventist Health Commercial |
$0.02
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
Rate for Payer: Blue Shield of California Commercial |
$0.07
|
Rate for Payer: Blue Shield of California EPN |
$0.07
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
Rate for Payer: Dignity Health Senior |
$0.10
|
Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
Rate for Payer: Heritage Provider Network Senior |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
Rate for Payer: Multiplan Commercial |
$0.09
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
IP
|
$6.58
|
|
Service Code
|
NDC 65649-401-30
|
Hospital Charge Code |
1748044
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.19 |
Max. Negotiated Rate |
$4.94 |
Rate for Payer: Adventist Health Commercial |
$1.32
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.52
|
Rate for Payer: Cash Price |
$2.96
|
Rate for Payer: EPIC Health Plan Commercial |
$3.55
|
Rate for Payer: Heritage Provider Network Commercial |
$4.45
|
Rate for Payer: Heritage Provider Network Senior |
$4.45
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
Rate for Payer: Multiplan Commercial |
$4.94
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
OP
|
$6.58
|
|
Service Code
|
NDC 65649-401-30
|
Hospital Charge Code |
1748044
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.19 |
Max. Negotiated Rate |
$5.59 |
Rate for Payer: Adventist Health Commercial |
$1.32
|
Rate for Payer: Aetna of CA Gatekeeper |
$3.52
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.52
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.59
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.62
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.94
|
Rate for Payer: Blue Shield of California Commercial |
$4.09
|
Rate for Payer: Blue Shield of California EPN |
$3.86
|
Rate for Payer: Cash Price |
$2.96
|
Rate for Payer: Cigna of CA HMO/PPO |
$4.28
|
Rate for Payer: Dignity Health Commercial/Exchange |
$5.59
|
Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
Rate for Payer: Dignity Health Senior |
$5.59
|
Rate for Payer: EPIC Health Plan Commercial |
$4.21
|
Rate for Payer: Heritage Provider Network Commercial |
$4.07
|
Rate for Payer: Heritage Provider Network Senior |
$4.07
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$3.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
Rate for Payer: Multiplan Commercial |
$4.94
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
Rate for Payer: Vantage Medical Group Senior |
$5.59
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
OP
|
$0.80
|
|
Service Code
|
NDC 64980-324-30
|
Hospital Charge Code |
1748044
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.14 |
Max. Negotiated Rate |
$0.68 |
Rate for Payer: Adventist Health Commercial |
$0.16
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.43
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.55
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.68
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.44
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.60
|
Rate for Payer: Blue Shield of California Commercial |
$0.50
|
Rate for Payer: Blue Shield of California EPN |
$0.47
|
Rate for Payer: Cash Price |
$0.36
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.52
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
Rate for Payer: Dignity Health Senior |
$0.68
|
Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
Rate for Payer: Heritage Provider Network Commercial |
$0.50
|
Rate for Payer: Heritage Provider Network Senior |
$0.50
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.39
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
Rate for Payer: Multiplan Commercial |
$0.60
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
OP
|
$2.77
|
|
Service Code
|
NDC 62559-431-30
|
Hospital Charge Code |
1748044
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.50 |
Max. Negotiated Rate |
$2.35 |
Rate for Payer: Adventist Health Commercial |
$0.55
|
Rate for Payer: Aetna of CA Gatekeeper |
$1.48
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.90
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.35
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.52
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.08
|
Rate for Payer: Blue Shield of California Commercial |
$1.72
|
Rate for Payer: Blue Shield of California EPN |
$1.63
|
Rate for Payer: Cash Price |
$1.25
|
Rate for Payer: Cigna of CA HMO/PPO |
$1.80
|
Rate for Payer: Dignity Health Commercial/Exchange |
$2.35
|
Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
Rate for Payer: Dignity Health Senior |
$2.35
|
Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
Rate for Payer: Heritage Provider Network Commercial |
$1.71
|
Rate for Payer: Heritage Provider Network Senior |
$1.71
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$1.34
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
Rate for Payer: Multiplan Commercial |
$2.08
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
IP
|
$2.77
|
|
Service Code
|
NDC 62559-431-30
|
Hospital Charge Code |
1748044
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.50 |
Max. Negotiated Rate |
$2.08 |
Rate for Payer: Adventist Health Commercial |
$0.55
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.90
|
Rate for Payer: Cash Price |
$1.25
|
Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
Rate for Payer: Heritage Provider Network Commercial |
$1.88
|
Rate for Payer: Heritage Provider Network Senior |
$1.88
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
Rate for Payer: Multiplan Commercial |
$2.08
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [28824]
|
Facility
IP
|
$0.80
|
|
Service Code
|
NDC 64980-324-30
|
Hospital Charge Code |
1748044
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.14 |
Max. Negotiated Rate |
$0.60 |
Rate for Payer: Adventist Health Commercial |
$0.16
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.55
|
Rate for Payer: Cash Price |
$0.36
|
Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
Rate for Payer: Heritage Provider Network Senior |
$0.54
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
Rate for Payer: Multiplan Commercial |
$0.60
|
|
HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]
|
Facility
OP
|
$0.16
|
|
Service Code
|
NDC 45802-014-02
|
Hospital Charge Code |
NDG3732
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
Rate for Payer: Blue Shield of California Commercial |
$0.10
|
Rate for Payer: Blue Shield of California EPN |
$0.09
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
Rate for Payer: Dignity Health Senior |
$0.14
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Senior |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.12
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]
|
Facility
IP
|
$0.16
|
|
Service Code
|
NDC 45802-014-02
|
Hospital Charge Code |
NDG3732
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.12 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
Rate for Payer: Cash Price |
$0.07
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Senior |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.12
|
|
HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]
|
Facility
IP
|
$0.14
|
|
Service Code
|
NDC 0168-0146-30
|
Hospital Charge Code |
1743576
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.11 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
Rate for Payer: Cash Price |
$0.06
|
Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
Rate for Payer: Heritage Provider Network Senior |
$0.09
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.11
|
|
HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]
|
Facility
OP
|
$0.14
|
|
Service Code
|
NDC 0168-0146-30
|
Hospital Charge Code |
1743576
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.12 |
Rate for Payer: Adventist Health Commercial |
$0.03
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
Rate for Payer: Blue Shield of California Commercial |
$0.09
|
Rate for Payer: Blue Shield of California EPN |
$0.08
|
Rate for Payer: Cash Price |
$0.06
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
Rate for Payer: Dignity Health Senior |
$0.12
|
Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
Rate for Payer: Heritage Provider Network Senior |
$0.09
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.11
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
HYDROCORTISONE 5 MG TABLET [10209]
|
Facility
OP
|
$0.21
|
|
Service Code
|
NDC 59762-0073-1
|
Hospital Charge Code |
1710846
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.18 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.11
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.18
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.16
|
Rate for Payer: Blue Shield of California Commercial |
$0.13
|
Rate for Payer: Blue Shield of California EPN |
$0.12
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
Rate for Payer: Dignity Health Senior |
$0.18
|
Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
Rate for Payer: Heritage Provider Network Senior |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.16
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
HYDROCORTISONE 5 MG TABLET [10209]
|
Facility
IP
|
$0.21
|
|
Service Code
|
NDC 59762-0073-1
|
Hospital Charge Code |
1710846
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.16 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
Rate for Payer: Heritage Provider Network Senior |
$0.14
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.16
|
|
HYDROCORTISONE 5 MG TABLET [10209]
|
Facility
OP
|
$0.34
|
|
Service Code
|
NDC 0115-1696-06
|
Hospital Charge Code |
1710846
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: Adventist Health Commercial |
$0.07
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
Rate for Payer: Blue Shield of California Commercial |
$0.21
|
Rate for Payer: Blue Shield of California EPN |
$0.20
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
Rate for Payer: Dignity Health Senior |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
Rate for Payer: Heritage Provider Network Senior |
$0.21
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.26
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
HYDROCORTISONE 5 MG TABLET [10209]
|
Facility
IP
|
$0.34
|
|
Service Code
|
NDC 0115-1696-06
|
Hospital Charge Code |
1710846
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.26 |
Rate for Payer: Adventist Health Commercial |
$0.07
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
Rate for Payer: Cash Price |
$0.15
|
Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
Rate for Payer: Heritage Provider Network Senior |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
Rate for Payer: Multiplan Commercial |
$0.26
|
|
HYDROCORTISONE ACETATE 0.5 % TOPICAL CREAM [3736]
|
Facility
IP
|
$0.07
|
|
Service Code
|
NDC 8770155397
|
Hospital Charge Code |
NDG3736
|
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 ACETATE 0.5 % TOPICAL CREAM [3736]
|
Facility
IP
|
$0.07
|
|
Service Code
|
NDC 24385-190-03
|
Hospital Charge Code |
NDG3736
|
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 ACETATE 0.5 % TOPICAL CREAM [3736]
|
Facility
OP
|
$0.07
|
|
Service Code
|
NDC 24385-190-03
|
Hospital Charge Code |
NDG3736
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
Rate for Payer: AlphaCare 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: Vantage Medical Group Medi-Cal |
$0.06
|
Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
HYDROCORTISONE ACETATE 0.5 % TOPICAL CREAM [3736]
|
Facility
OP
|
$0.07
|
|
Service Code
|
NDC 8770155397
|
Hospital Charge Code |
NDG3736
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
Rate for Payer: AlphaCare 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: Vantage Medical Group Medi-Cal |
$0.06
|
Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
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 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: AlphaCare Medical Group Commercial/Exchange |
$12.04
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.79
|
Rate for Payer: AlphaCare 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: Vantage Medical Group Medi-Cal |
$12.04
|
Rate for Payer: Vantage Medical Group Senior |
$12.04
|
|