|
PHOSPHATE DIALY SOLN W-OUT CALCIUM,DEX K 4 MEQ-MG 1.5 MEQ-PO4 1 MMOL/L [212682]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 2457111705
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
|
OP
|
$38.40
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Adventist Health Commercial |
$10.26
|
| Rate for Payer: Adventist Health Commercial |
$11.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$5.48
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.21
|
| Rate for Payer: Heritage Provider Network Senior |
$23.76
|
| Rate for Payer: Heritage Provider Network Senior |
$17.78
|
| Rate for Payer: Heritage Provider Network Senior |
$27.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.92
|
| Rate for Payer: Multiplan Commercial |
$38.49
|
| Rate for Payer: Multiplan Commercial |
$44.07
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.50
|
| Rate for Payer: TriValley Medical Group Senior |
$23.50
|
| Rate for Payer: TriValley Medical Group Senior |
$20.53
|
| Rate for Payer: TriValley Medical Group Senior |
$15.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.62
|
| Rate for Payer: Vantage Medical Group Senior |
$32.64
|
| Rate for Payer: Vantage Medical Group Senior |
$49.95
|
| Rate for Payer: Vantage Medical Group Senior |
$43.62
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION [11023]
|
Facility
|
IP
|
$58.76
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$44.07 |
| Rate for Payer: Adventist Health Commercial |
$11.75
|
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Adventist Health Commercial |
$10.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.76
|
| Rate for Payer: Heritage Provider Network Senior |
$23.76
|
| Rate for Payer: Heritage Provider Network Senior |
$17.78
|
| Rate for Payer: Heritage Provider Network Senior |
$27.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.69
|
| Rate for Payer: Multiplan Commercial |
$44.07
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$38.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.99
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
|
IP
|
$11.79
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.59
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.46
|
| Rate for Payer: Heritage Provider Network Senior |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$8.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.90
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [110478]
|
Facility
|
OP
|
$11.79
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$5.48
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.46
|
| Rate for Payer: Heritage Provider Network Senior |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$8.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Senior |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Vantage Medical Group Senior |
$10.02
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [6271]
|
Facility
|
OP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$5.48
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.48
|
| Rate for Payer: Heritage Provider Network Senior |
$27.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.55
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.74
|
| Rate for Payer: TriValley Medical Group Senior |
$23.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Vantage Medical Group Senior |
$50.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE [6271]
|
Facility
|
IP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$44.51 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.22
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.48
|
| Rate for Payer: Heritage Provider Network Senior |
$27.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.84
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.65
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML ORAL SYRINGE [4081654]
|
Facility
|
IP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$44.51 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.22
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.48
|
| Rate for Payer: Heritage Provider Network Senior |
$27.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.84
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.65
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML ORAL SYRINGE [4081654]
|
Facility
|
OP
|
$59.35
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Adventist Health Commercial |
$11.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$5.48
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.48
|
| Rate for Payer: Heritage Provider Network Senior |
$27.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.55
|
| Rate for Payer: Multiplan Commercial |
$44.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.74
|
| Rate for Payer: TriValley Medical Group Senior |
$23.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.45
|
| Rate for Payer: Vantage Medical Group Senior |
$50.45
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$33.76
|
|
|
Service Code
|
NDC 7071010143
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.70
|
| Rate for Payer: Adventist Health Commercial |
$6.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.89
|
| Rate for Payer: Blue Shield of California Commercial |
$20.59
|
| Rate for Payer: Blue Shield of California EPN |
$16.47
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.90
|
| Rate for Payer: Heritage Provider Network Senior |
$20.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.63
|
| Rate for Payer: Multiplan Commercial |
$25.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Senior |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.70
|
| Rate for Payer: Vantage Medical Group Senior |
$28.70
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$80.85
|
|
|
Service Code
|
NDC 6068738111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$60.64 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.07
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.74
|
| Rate for Payer: Heritage Provider Network Senior |
$54.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$60.64
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$33.76
|
|
|
Service Code
|
NDC 7071010143
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$25.32 |
| Rate for Payer: Adventist Health Commercial |
$6.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.74
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.86
|
| Rate for Payer: Heritage Provider Network Senior |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$25.32
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$80.85
|
|
|
Service Code
|
NDC 6068738194
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.44
|
| Rate for Payer: Blue Shield of California Commercial |
$49.32
|
| Rate for Payer: Blue Shield of California EPN |
$39.45
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.05
|
| Rate for Payer: Heritage Provider Network Senior |
$50.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.59
|
| Rate for Payer: Multiplan Commercial |
$60.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.34
|
| Rate for Payer: TriValley Medical Group Senior |
$32.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Vantage Medical Group Senior |
$68.72
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$80.85
|
|
|
Service Code
|
NDC 6068738194
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$60.64 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.07
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.74
|
| Rate for Payer: Heritage Provider Network Senior |
$54.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$60.64
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
NDC 6923810513
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.91
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Senior |
$32.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
NDC 6923810513
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.01
|
| Rate for Payer: Blue Shield of California Commercial |
$29.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.71
|
| Rate for Payer: Heritage Provider Network Senior |
$29.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$22.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$80.85
|
|
|
Service Code
|
NDC 6068738111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Adventist Health Commercial |
$16.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.44
|
| Rate for Payer: Blue Shield of California Commercial |
$49.32
|
| Rate for Payer: Blue Shield of California EPN |
$39.45
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.05
|
| Rate for Payer: Heritage Provider Network Senior |
$50.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.59
|
| Rate for Payer: Multiplan Commercial |
$60.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.34
|
| Rate for Payer: TriValley Medical Group Senior |
$32.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.72
|
| Rate for Payer: Vantage Medical Group Senior |
$68.72
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
OP
|
$27.01
|
|
|
Service Code
|
NDC 6909799902
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.51
|
| Rate for Payer: Blue Shield of California Commercial |
$16.48
|
| Rate for Payer: Blue Shield of California EPN |
$13.18
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.72
|
| Rate for Payer: Heritage Provider Network Senior |
$16.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.91
|
| Rate for Payer: Multiplan Commercial |
$20.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.96
|
| Rate for Payer: Vantage Medical Group Senior |
$22.96
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET [11024]
|
Facility
|
IP
|
$27.01
|
|
|
Service Code
|
NDC 6909799902
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.39
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.29
|
| Rate for Payer: Heritage Provider Network Senior |
$18.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$20.26
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
OP
|
$5.94
|
|
|
Service Code
|
NDC 7006918101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Adventist Health Commercial |
$1.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3.62
|
| Rate for Payer: Blue Shield of California EPN |
$2.90
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.68
|
| Rate for Payer: Heritage Provider Network Senior |
$3.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.38
|
| Rate for Payer: TriValley Medical Group Senior |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5.05
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
OP
|
$6.31
|
|
|
Service Code
|
NDC 6131420315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.91
|
| Rate for Payer: Heritage Provider Network Senior |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
IP
|
$6.31
|
|
|
Service Code
|
NDC 6131420315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.06
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 6923817458
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3.07
|
| Rate for Payer: Blue Shield of California EPN |
$2.46
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
IP
|
$5.94
|
|
|
Service Code
|
NDC 7006918101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Adventist Health Commercial |
$1.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.83
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.02
|
| Rate for Payer: Heritage Provider Network Senior |
$4.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$4.46
|
|
|
PILOCARPINE 1 % EYE DROPS [6279]
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 6923817458
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.25
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
|
