|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 904615760
|
| Hospital Charge Code |
1712537
|
|
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: Central Health Plan Commercial |
$0.02
|
| 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: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| 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
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 904615760
|
| Hospital Charge Code |
1712537
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| 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: 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 Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
OP
|
$0.30
|
|
|
Service Code
|
NDC 5026886511
|
| Hospital Charge Code |
1712537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: Riverside University Health MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
IP
|
$0.30
|
|
|
Service Code
|
NDC 5026886511
|
| Hospital Charge Code |
1712537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 8068117000
|
| Hospital Charge Code |
1712537
|
|
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: Central Health Plan Commercial |
$0.02
|
| 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: Health Management Network EPO/PPO |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.02
|
| 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
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 7985404112
|
| Hospital Charge Code |
1712537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| 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: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| 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
|
|
|
CHOLECYSTECTOMY
|
Facility
IP
|
$12,705.59
|
|
|
Service Code
|
APR-DRG 2631
|
| Min. Negotiated Rate |
$10,662.04 |
| Max. Negotiated Rate |
$12,705.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,662.04
|
| Rate for Payer: IEHP medi-cal |
$12,705.59
|
|
|
CHOLECYSTECTOMY
|
Facility
IP
|
$37,707.03
|
|
|
Service Code
|
APR-DRG 2634
|
| Min. Negotiated Rate |
$31,642.26 |
| Max. Negotiated Rate |
$37,707.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$31,642.26
|
| Rate for Payer: IEHP medi-cal |
$37,707.03
|
|
|
CHOLECYSTECTOMY
|
Facility
IP
|
$20,432.54
|
|
|
Service Code
|
APR-DRG 2633
|
| Min. Negotiated Rate |
$17,146.19 |
| Max. Negotiated Rate |
$20,432.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,146.19
|
| Rate for Payer: IEHP medi-cal |
$20,432.54
|
|
|
CHOLECYSTECTOMY
|
Facility
IP
|
$16,105.23
|
|
|
Service Code
|
APR-DRG 2632
|
| Min. Negotiated Rate |
$13,514.88 |
| Max. Negotiated Rate |
$16,105.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,514.88
|
| Rate for Payer: IEHP medi-cal |
$16,105.23
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
OP
|
$2.46
|
|
|
Service Code
|
NDC 49884-465-64
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.45
|
| Rate for Payer: BCBS Transplant Transplant |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.84
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: Riverside University Health MISP |
$0.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
IP
|
$1.16
|
|
|
Service Code
|
NDC 67877-298-09
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
NDC 67877-298-60
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: BCBS Transplant Transplant |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.87
|
| Rate for Payer: IEHP medi-cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: Riverside University Health MISP |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
OP
|
$2.46
|
|
|
Service Code
|
NDC 49884-465-65
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.45
|
| Rate for Payer: BCBS Transplant Transplant |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.84
|
| Rate for Payer: IEHP medi-cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: Riverside University Health MISP |
$0.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
IP
|
$2.46
|
|
|
Service Code
|
NDC 49884-465-64
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
IP
|
$2.46
|
|
|
Service Code
|
NDC 49884-465-65
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$1.72
|
| Rate for Payer: Cigna of CA PPO |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: Galaxy Health WC |
$2.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.09
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
NDC 67877-298-09
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: BCBS Transplant Transplant |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.87
|
| Rate for Payer: IEHP medi-cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: Riverside University Health MISP |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
IP
|
$1.16
|
|
|
Service Code
|
NDC 67877-298-60
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.35 ML)1 %(0.4 ML)INTRAOCULAR SYRING [28916]
|
Facility
IP
|
$378.13
|
|
|
Service Code
|
NDC 8065183135
|
| Hospital Charge Code |
NDG28916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.63 |
| Max. Negotiated Rate |
$340.32 |
| Rate for Payer: Blue Shield of California Commercial |
$283.60
|
| Rate for Payer: Blue Shield of California EPN |
$201.92
|
| Rate for Payer: Cash Price |
$170.16
|
| Rate for Payer: Central Health Plan Commercial |
$302.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.25
|
| Rate for Payer: Galaxy Health WC |
$321.41
|
| Rate for Payer: Global Benefits Group Commercial |
$226.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.63
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
| Rate for Payer: Networks By Design Commercial |
$245.78
|
| Rate for Payer: Prime Health Services Commercial |
$321.41
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.35 ML)1 %(0.4 ML)INTRAOCULAR SYRING [28916]
|
Facility
OP
|
$378.13
|
|
|
Service Code
|
NDC 8065183135
|
| Hospital Charge Code |
NDG28916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.63 |
| Max. Negotiated Rate |
$340.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$229.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$321.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$207.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$207.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.40
|
| Rate for Payer: BCBS Transplant Transplant |
$226.88
|
| Rate for Payer: Blue Shield of California Commercial |
$237.84
|
| Rate for Payer: Blue Shield of California EPN |
$184.91
|
| Rate for Payer: Cash Price |
$170.16
|
| Rate for Payer: Cash Price |
$170.16
|
| Rate for Payer: Central Health Plan Commercial |
$302.50
|
| Rate for Payer: Cigna of CA HMO |
$242.00
|
| Rate for Payer: Cigna of CA PPO |
$279.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$151.25
|
| Rate for Payer: Galaxy Health WC |
$321.41
|
| Rate for Payer: Global Benefits Group Commercial |
$226.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$283.60
|
| Rate for Payer: IEHP medi-cal |
$132.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.63
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
| Rate for Payer: Networks By Design Commercial |
$245.78
|
| Rate for Payer: Prime Health Services Commercial |
$321.41
|
| Rate for Payer: Riverside University Health MISP |
$151.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.06
|
| Rate for Payer: United Healthcare All Other HMO |
$189.06
|
| Rate for Payer: United Healthcare HMO Rider |
$189.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$321.41
|
| Rate for Payer: Vantage Medical Group Senior |
$321.41
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE [28923]
|
Facility
IP
|
$431.64
|
|
|
Service Code
|
NDC 8065183905
|
| Hospital Charge Code |
1720965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$388.48 |
| Rate for Payer: Cash Price |
$194.24
|
| Rate for Payer: Central Health Plan Commercial |
$345.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.66
|
| Rate for Payer: Galaxy Health WC |
$366.89
|
| Rate for Payer: Global Benefits Group Commercial |
$258.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$388.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.33
|
| Rate for Payer: Multiplan Commercial |
$323.73
|
| Rate for Payer: Networks By Design Commercial |
$280.57
|
| Rate for Payer: Prime Health Services Commercial |
$366.89
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE [28923]
|
Facility
OP
|
$431.64
|
|
|
Service Code
|
NDC 8065183905
|
| Hospital Charge Code |
1720965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$388.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$262.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$366.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$237.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$237.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.01
|
| Rate for Payer: BCBS Transplant Transplant |
$258.98
|
| Rate for Payer: Blue Shield of California Commercial |
$271.50
|
| Rate for Payer: Blue Shield of California EPN |
$211.07
|
| Rate for Payer: Cash Price |
$194.24
|
| Rate for Payer: Central Health Plan Commercial |
$345.31
|
| Rate for Payer: Cigna of CA HMO |
$276.25
|
| Rate for Payer: Cigna of CA PPO |
$319.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$366.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.66
|
| Rate for Payer: Galaxy Health WC |
$366.89
|
| Rate for Payer: Global Benefits Group Commercial |
$258.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$388.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$323.73
|
| Rate for Payer: IEHP medi-cal |
$151.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.33
|
| Rate for Payer: Multiplan Commercial |
$323.73
|
| Rate for Payer: Networks By Design Commercial |
$280.57
|
| Rate for Payer: Prime Health Services Commercial |
$366.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$258.98
|
| Rate for Payer: Riverside University Health MISP |
$172.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.82
|
| Rate for Payer: United Healthcare All Other HMO |
$215.82
|
| Rate for Payer: United Healthcare HMO Rider |
$215.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$366.89
|
| Rate for Payer: Vantage Medical Group Senior |
$366.89
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION [1685]
|
Facility
OP
|
$2.38
|
|
|
Service Code
|
NDC 0409-4093-01
|
| Hospital Charge Code |
1757538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: BCBS Transplant Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.78
|
| Rate for Payer: IEHP medi-cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
| Rate for Payer: Riverside University Health MISP |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.02
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION [1685]
|
Facility
IP
|
$2.38
|
|
|
Service Code
|
NDC 0409-4093-01
|
| Hospital Charge Code |
1757538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.27
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
|
|
Chromotubation of oviduct, including materials
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 58350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,214.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$6,214.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,389.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,214.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,191.89
|
| Rate for Payer: IEHP medi-cal |
$10,254.04
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Innovage PACE Commercial |
$9,321.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,214.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,327.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,327.52
|
| Rate for Payer: Prime Health Services Medicare |
$6,587.44
|
| Rate for Payer: Riverside University Health MISP |
$6,836.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
