|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
IP
|
$17.81
|
|
|
Service Code
|
NDC 0008084402
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$13.36 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.47
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.06
|
| Rate for Payer: Heritage Provider Network Senior |
$12.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$13.36
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
OP
|
$16.99
|
|
|
Service Code
|
NDC 6275607164
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.50
|
| Rate for Payer: Blue Shield of California Commercial |
$10.36
|
| Rate for Payer: Blue Shield of California EPN |
$8.29
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.80
|
| Rate for Payer: TriValley Medical Group Senior |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.44
|
| Rate for Payer: Vantage Medical Group Senior |
$14.44
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
OP
|
$16.99
|
|
|
Service Code
|
NDC 6068776799
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.50
|
| Rate for Payer: Blue Shield of California Commercial |
$10.36
|
| Rate for Payer: Blue Shield of California EPN |
$8.29
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.80
|
| Rate for Payer: TriValley Medical Group Senior |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.44
|
| Rate for Payer: Vantage Medical Group Senior |
$14.44
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
IP
|
$16.99
|
|
|
Service Code
|
NDC 6068776799
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.94
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
IP
|
$16.99
|
|
|
Service Code
|
NDC 6275607164
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.94
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
IP
|
$7.98
|
|
|
Service Code
|
NDC 2724125638
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.14
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.40
|
| Rate for Payer: Heritage Provider Network Senior |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$5.99
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
OP
|
$7.98
|
|
|
Service Code
|
NDC 2724125611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.78 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.99
|
| Rate for Payer: Blue Shield of California Commercial |
$4.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.89
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.94
|
| Rate for Payer: Heritage Provider Network Senior |
$4.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.19
|
| Rate for Payer: TriValley Medical Group Senior |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.78
|
| Rate for Payer: Vantage Medical Group Senior |
$6.78
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
OP
|
$17.81
|
|
|
Service Code
|
NDC 0008084402
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.91
|
| Rate for Payer: Blue Shield of California Commercial |
$10.86
|
| Rate for Payer: Blue Shield of California EPN |
$8.69
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Senior |
$11.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.47
|
| Rate for Payer: Multiplan Commercial |
$13.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.12
|
| Rate for Payer: TriValley Medical Group Senior |
$7.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Vantage Medical Group Senior |
$15.14
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
OP
|
$16.99
|
|
|
Service Code
|
NDC 6068776727
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.50
|
| Rate for Payer: Blue Shield of California Commercial |
$10.36
|
| Rate for Payer: Blue Shield of California EPN |
$8.29
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.80
|
| Rate for Payer: TriValley Medical Group Senior |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.44
|
| Rate for Payer: Vantage Medical Group Senior |
$14.44
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
IP
|
$16.99
|
|
|
Service Code
|
NDC 6068776727
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.94
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
OP
|
$7.98
|
|
|
Service Code
|
NDC 2724125638
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.78 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.93
|
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.99
|
| Rate for Payer: Blue Shield of California Commercial |
$4.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.89
|
| Rate for Payer: Cash Price |
$3.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.94
|
| Rate for Payer: Heritage Provider Network Senior |
$4.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.19
|
| Rate for Payer: TriValley Medical Group Senior |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.78
|
| Rate for Payer: Vantage Medical Group Senior |
$6.78
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
|
OP
|
$17.81
|
|
|
Service Code
|
NDC 0008084401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: Adventist Health Commercial |
$3.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.91
|
| Rate for Payer: Blue Shield of California Commercial |
$10.86
|
| Rate for Payer: Blue Shield of California EPN |
$8.69
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Senior |
$11.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.47
|
| Rate for Payer: Multiplan Commercial |
$13.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.12
|
| Rate for Payer: TriValley Medical Group Senior |
$7.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Vantage Medical Group Senior |
$15.14
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]
|
Facility
|
IP
|
$24.85
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.56
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.42
|
| Rate for Payer: Heritage Provider Network Senior |
$10.42
|
| Rate for Payer: Heritage Provider Network Senior |
$9.03
|
| Rate for Payer: Heritage Provider Network Senior |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.21
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.45
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]
|
Facility
|
OP
|
$19.50
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.30
|
| Rate for Payer: Blue Shield of California Commercial |
$35.95
|
| Rate for Payer: Blue Shield of California Commercial |
$35.95
|
| Rate for Payer: Blue Shield of California Commercial |
$35.95
|
| Rate for Payer: Blue Shield of California EPN |
$35.95
|
| Rate for Payer: Blue Shield of California EPN |
$35.95
|
| Rate for Payer: Blue Shield of California EPN |
$35.95
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.51
|
| Rate for Payer: Heritage Provider Network Senior |
$10.42
|
| Rate for Payer: Heritage Provider Network Senior |
$9.03
|
| Rate for Payer: Heritage Provider Network Senior |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Senior |
$9.94
|
| Rate for Payer: TriValley Medical Group Senior |
$9.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.12
|
| Rate for Payer: Vantage Medical Group Senior |
$16.57
|
| Rate for Payer: Vantage Medical Group Senior |
$21.12
|
| Rate for Payer: Vantage Medical Group Senior |
$19.12
|
|
|
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
|
Facility
|
OP
|
$14,466.39
|
|
|
Service Code
|
CPT 60500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,613.89 |
| Max. Negotiated Rate |
$14,466.39 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,613.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9,365.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,466.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,755.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,375.28
|
| Rate for Payer: TriValley Medical Group Senior |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION [222465]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0338050206
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION [222465]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0338050206
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| 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 |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.6 INTRAVENOUS SOLUTION [224619]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 0264450000
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.6 INTRAVENOUS SOLUTION [224619]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 0264450000
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 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: Cigna of CA HMO/PPO |
$0.03
|
| 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: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| 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: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 4948368703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 4948368703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
|
IP
|
$1.78
|
|
|
Service Code
|
NDC 6586293630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
NDC 6586293630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 6945214613
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.88
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Senior |
$4.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 6945214613
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.44
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
