|
VIRAL ILLNESS
|
Facility
|
IP
|
$12,213.83
|
|
|
Service Code
|
APR-DRG 7233
|
| Min. Negotiated Rate |
$9,369.29 |
| Max. Negotiated Rate |
$12,213.83 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,369.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,213.83
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$5,705.22
|
|
|
Service Code
|
APR-DRG 7231
|
| Min. Negotiated Rate |
$4,376.51 |
| Max. Negotiated Rate |
$5,705.22 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,376.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,705.22
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$8,138.40
|
|
|
Service Code
|
APR-DRG 7232
|
| Min. Negotiated Rate |
$6,243.01 |
| Max. Negotiated Rate |
$8,138.40 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,243.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,138.40
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$37,038.71
|
|
|
Service Code
|
APR-DRG 0514
|
| Min. Negotiated Rate |
$28,412.59 |
| Max. Negotiated Rate |
$37,038.71 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28,412.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37,038.71
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$18,626.65
|
|
|
Service Code
|
APR-DRG 0513
|
| Min. Negotiated Rate |
$14,288.60 |
| Max. Negotiated Rate |
$18,626.65 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,288.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,626.65
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$11,206.48
|
|
|
Service Code
|
APR-DRG 0512
|
| Min. Negotiated Rate |
$8,596.55 |
| Max. Negotiated Rate |
$11,206.48 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,596.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,206.48
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$7,441.44
|
|
|
Service Code
|
APR-DRG 0511
|
| Min. Negotiated Rate |
$5,708.37 |
| Max. Negotiated Rate |
$7,441.44 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,708.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,441.44
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0761-0433-10
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 8770140725
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Distinction Transplant |
$0.03
|
| 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 |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 8770140725
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 35046-001-06
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: Blue Distinction Transplant |
$0.03
|
| 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 |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 35046-001-06
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0761-0433-10
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
VITAMIN A ORAL SOLUTION (IV FORM) 50,000 UNITS/ML [4080447]
|
Facility
|
IP
|
$20.89
|
|
|
Service Code
|
NDC 9994-0804-47
|
| Hospital Charge Code |
1715203
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Blue Shield of California Commercial |
$14.87
|
| Rate for Payer: Blue Shield of California EPN |
$10.70
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cigna of CA HMO |
$14.62
|
| Rate for Payer: Cigna of CA PPO |
$14.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.36
|
| Rate for Payer: Galaxy Health WC |
$17.76
|
| Rate for Payer: Global Benefits Group Commercial |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.01
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$13.58
|
| Rate for Payer: Prime Health Services Commercial |
$17.76
|
|
|
VITAMIN A ORAL SOLUTION (IV FORM) 50,000 UNITS/ML [4080447]
|
Facility
|
OP
|
$20.89
|
|
|
Service Code
|
NDC 9994-0804-47
|
| Hospital Charge Code |
1715203
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.45
|
| Rate for Payer: Blue Distinction Transplant |
$12.53
|
| Rate for Payer: Blue Shield of California Commercial |
$15.40
|
| Rate for Payer: Blue Shield of California EPN |
$12.20
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cigna of CA HMO |
$14.62
|
| Rate for Payer: Cigna of CA PPO |
$14.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.76
|
| Rate for Payer: Dignity Health Media |
$17.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.36
|
| Rate for Payer: Galaxy Health WC |
$17.76
|
| Rate for Payer: Global Benefits Group Commercial |
$12.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.01
|
| Rate for Payer: Multiplan Commercial |
$16.71
|
| Rate for Payer: Networks By Design Commercial |
$13.58
|
| Rate for Payer: Prime Health Services Commercial |
$17.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.44
|
| Rate for Payer: United Healthcare All Other HMO |
$10.44
|
| Rate for Payer: United Healthcare HMO Rider |
$10.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.76
|
| Rate for Payer: Vantage Medical Group Senior |
$17.76
|
|
|
VITAMIN A PALMITATE 250 MCG-VIT C 50 MG-VIT D3 10 MCG/ML ORAL DROPS [228286]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 87040303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
VITAMIN A PALMITATE 250 MCG-VIT C 50 MG-VIT D3 10 MCG/ML ORAL DROPS [228286]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 87040303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Distinction Transplant |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Media |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
VITAMIN A PALMITATE 3,000 MCG (10,000 UNIT) CAPSULE [113607]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 4098521464
|
| Hospital Charge Code |
1711121
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
|
VITAMIN A PALMITATE 3,000 MCG (10,000 UNIT) CAPSULE [113607]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 4098521464
|
| Hospital Charge Code |
1711121
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Distinction Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.02
|
| Rate for Payer: Cigna of CA PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Media |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
VITAMIN A PALMITATE 50,000 UNIT/ML INTRAMUSCULAR SOLUTION [11641]
|
Facility
|
IP
|
$431.25
|
|
|
Service Code
|
NDC 70199-026-11
|
| Hospital Charge Code |
NDG11641
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$366.56 |
| Rate for Payer: Blue Shield of California Commercial |
$307.05
|
| Rate for Payer: Blue Shield of California EPN |
$220.80
|
| Rate for Payer: Cash Price |
$194.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.50
|
| Rate for Payer: Galaxy Health WC |
$366.56
|
| Rate for Payer: Global Benefits Group Commercial |
$258.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$280.31
|
| Rate for Payer: Prime Health Services Commercial |
$366.56
|
|
|
VITAMIN A PALMITATE 50,000 UNIT/ML INTRAMUSCULAR SOLUTION [11641]
|
Facility
|
OP
|
$431.25
|
|
|
Service Code
|
NDC 70199-026-11
|
| Hospital Charge Code |
NDG11641
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$366.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$366.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$237.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.94
|
| Rate for Payer: Blue Distinction Transplant |
$258.75
|
| Rate for Payer: Blue Shield of California Commercial |
$317.83
|
| Rate for Payer: Blue Shield of California EPN |
$251.85
|
| Rate for Payer: Cash Price |
$194.06
|
| Rate for Payer: Cigna of CA HMO |
$276.00
|
| Rate for Payer: Cigna of CA PPO |
$319.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$366.56
|
| Rate for Payer: Dignity Health Media |
$366.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$366.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.50
|
| Rate for Payer: Galaxy Health WC |
$366.56
|
| Rate for Payer: Global Benefits Group Commercial |
$258.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$323.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$280.31
|
| Rate for Payer: Prime Health Services Commercial |
$366.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.62
|
| Rate for Payer: United Healthcare All Other HMO |
$215.62
|
| Rate for Payer: United Healthcare HMO Rider |
$215.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$366.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$366.56
|
| Rate for Payer: Vantage Medical Group Senior |
$366.56
|
|
|
VITAMIN B COMPLEX CAPSULE [804]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 7985420080
|
| Hospital Charge Code |
ERX804
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$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 |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
VITAMIN B COMPLEX CAPSULE [804]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 536478701
|
| Hospital Charge Code |
ERX804
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
