|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.06
|
| Rate for Payer: Blue Shield of California EPN |
$15.12
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Other HMO |
$10.96
|
| Rate for Payer: United Healthcare HMO Rider |
$10.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$17.32
|
| Rate for Payer: Blue Shield of California EPN |
$10.89
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Central Health Plan Commercial |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.07
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
|
OP
|
$21.60
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$235.47 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.47
|
| Rate for Payer: Blue Shield of California Commercial |
$28.38
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Central Health Plan Commercial |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: Riverside University Health System MISP |
$8.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$24,875.26
|
|
|
Service Code
|
APR-DRG 7234
|
| Min. Negotiated Rate |
$15,710.69 |
| Max. Negotiated Rate |
$24,875.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,710.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,721.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,875.26
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$5,925.74
|
|
|
Service Code
|
APR-DRG 7231
|
| Min. Negotiated Rate |
$3,742.57 |
| Max. Negotiated Rate |
$5,925.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,742.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,459.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,925.74
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$13,547.44
|
|
|
Service Code
|
APR-DRG 7233
|
| Min. Negotiated Rate |
$8,556.28 |
| Max. Negotiated Rate |
$13,547.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,556.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,196.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,547.44
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$8,707.34
|
|
|
Service Code
|
APR-DRG 7232
|
| Min. Negotiated Rate |
$5,499.37 |
| Max. Negotiated Rate |
$8,707.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,499.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,553.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,707.34
|
|
|
VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$39,433.76
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$39,433.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,433.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,472.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,662.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,584.30
|
| Rate for Payer: EPIC Health Plan Senior |
$23,722.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,566.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,192.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,898.76
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,566.24
|
| Rate for Payer: Prime Health Services Medicare |
$22,860.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$22,887.00
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$22,887.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,887.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,784.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,698.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,277.05
|
| Rate for Payer: EPIC Health Plan Senior |
$14,184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,895.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,053.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,279.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,895.18
|
| Rate for Payer: Prime Health Services Medicare |
$13,668.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$13,382.27
|
|
|
Service Code
|
APR-DRG 0512
|
| Min. Negotiated Rate |
$8,451.96 |
| Max. Negotiated Rate |
$13,382.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,451.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,071.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,382.27
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$20,256.72
|
|
|
Service Code
|
APR-DRG 0513
|
| Min. Negotiated Rate |
$12,793.72 |
| Max. Negotiated Rate |
$20,256.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,793.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,245.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,256.72
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$34,607.82
|
|
|
Service Code
|
APR-DRG 0514
|
| Min. Negotiated Rate |
$21,857.57 |
| Max. Negotiated Rate |
$34,607.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,857.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,046.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,607.82
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$9,903.77
|
|
|
Service Code
|
APR-DRG 0511
|
| Min. Negotiated Rate |
$6,255.01 |
| Max. Negotiated Rate |
$9,903.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,255.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,453.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,903.77
|
|
|
VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$50,466.68
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$50,466.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,466.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,599.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,640.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,123.95
|
| Rate for Payer: EPIC Health Plan Senior |
$30,082.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,347.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,286.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,646.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27,347.85
|
| Rate for Payer: Prime Health Services Medicare |
$28,988.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,266.57
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$20,266.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,707.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,730.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,822.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,266.57
|
| Rate for Payer: EPIC Health Plan Senior |
$13,511.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,282.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,195.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,458.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,282.77
|
| Rate for Payer: Prime Health Services Medicare |
$13,019.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 0904208560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: 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: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.03
|
| 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
|
$0.05
|
|
|
Service Code
|
NDC 0904208560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: 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 |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Central Health Plan Commercial |
$0.04
|
| 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 Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| 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: Riverside University Health System MISP |
$0.02
|
| 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 3504600106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| 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: Central Health Plan Commercial |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| 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 |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$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
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 3504600106
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| 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 |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Central Health Plan Commercial |
$0.03
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| 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 |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| 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: Riverside University Health System MISP |
$0.02
|
| 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 ORAL SOLUTION (IV FORM) 50,000 UNITS/ML [4080447]
|
Facility
|
IP
|
$20.89
|
|
|
Service Code
|
NDC 9994080447
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Adventist Health Commercial |
$4.18
|
| Rate for Payer: Blue Shield of California Commercial |
$16.75
|
| Rate for Payer: Blue Shield of California EPN |
$10.53
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Central Health Plan Commercial |
$16.71
|
| Rate for Payer: Cigna of CA HMO |
$14.62
|
| Rate for Payer: Cigna of CA PPO |
$14.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.36
|
| Rate for Payer: EPIC Health Plan Senior |
$8.36
|
| Rate for Payer: Galaxy Health WC |
$17.76
|
| Rate for Payer: Global Benefits Group Commercial |
$12.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: Multiplan Commercial |
$15.67
|
| 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 9994080447
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Adventist Health Commercial |
$4.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.69
|
| 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 |
$15.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.15
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Blue Shield of California EPN |
$8.34
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Central Health Plan Commercial |
$16.71
|
| 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 Medi-Cal |
$17.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.36
|
| Rate for Payer: EPIC Health Plan Senior |
$8.36
|
| Rate for Payer: Galaxy Health WC |
$17.76
|
| Rate for Payer: Global Benefits Group Commercial |
$12.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.62
|
| Rate for Payer: Multiplan Commercial |
$15.67
|
| Rate for Payer: Networks By Design Commercial |
$13.58
|
| Rate for Payer: Prime Health Services Commercial |
$17.76
|
| Rate for Payer: Riverside University Health System MISP |
$8.36
|
| 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 |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| 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 20,000 IU (6,000 MCG) PER 1 ML ORAL DROPS [4082303]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 1007847420
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
VITAMIN A PALMITATE 20,000 IU (6,000 MCG) PER 1 ML ORAL DROPS [4082303]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 1007847420
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
VITAMIN A PALMITATE 250 MCG-VIT C 50 MG-VIT D3 10 MCG/ML ORAL DROPS [228286]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 0087040303
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| 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 |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| 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 Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| 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 250 MCG-VIT C 50 MG-VIT D3 10 MCG/ML ORAL DROPS [228286]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 0087040303
|
| Hospital Charge Code |
901700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
