|
PORACTANT ALFA 240 MG/3 ML INTRATRACHEAL SUSPENSION [117872]
|
Facility
|
IP
|
$495.58
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$371.69 |
| Rate for Payer: Adventist Health Commercial |
$99.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$319.15
|
| Rate for Payer: Cash Price |
$223.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.45
|
| Rate for Payer: Heritage Provider Network Senior |
$229.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.89
|
| Rate for Payer: Multiplan Commercial |
$371.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$179.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.09
|
|
|
PORFIMER 75 MG INTRAVENOUS SOLUTION [14472]
|
Facility
|
IP
|
$27,987.60
|
|
|
Service Code
|
HCPCS J9600
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,065.76 |
| Max. Negotiated Rate |
$20,990.70 |
| Rate for Payer: Adventist Health Commercial |
$5,597.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,024.01
|
| Rate for Payer: Cash Price |
$12,594.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,874.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,113.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,958.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12,958.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,065.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,996.90
|
| Rate for Payer: Multiplan Commercial |
$20,990.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,111.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,266.69
|
|
|
PORFIMER 75 MG INTRAVENOUS SOLUTION [14472]
|
Facility
|
OP
|
$27,987.60
|
|
|
Service Code
|
HCPCS J9600
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,065.76 |
| Max. Negotiated Rate |
$23,789.46 |
| Rate for Payer: Adventist Health Commercial |
$5,597.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,296.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,789.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,393.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,990.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,358.10
|
| Rate for Payer: Blue Shield of California Commercial |
$23,789.46
|
| Rate for Payer: Blue Shield of California EPN |
$23,789.46
|
| Rate for Payer: Cash Price |
$12,594.42
|
| Rate for Payer: Cash Price |
$12,594.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,874.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,789.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,789.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,789.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,912.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,958.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12,958.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,350.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,065.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,996.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,591.32
|
| Rate for Payer: Multiplan Commercial |
$20,990.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,195.04
|
| Rate for Payer: TriValley Medical Group Senior |
$11,195.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,111.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,266.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,789.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,789.46
|
| Rate for Payer: Vantage Medical Group Senior |
$23,789.46
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 7074825807
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 7074825807
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.80
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 0527213335
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$59.25
|
|
|
Service Code
|
NDC 0904714904
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$50.36 |
| Rate for Payer: Adventist Health Commercial |
$11.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.64
|
| Rate for Payer: Blue Shield of California Commercial |
$36.14
|
| Rate for Payer: Blue Shield of California EPN |
$28.91
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.68
|
| Rate for Payer: Heritage Provider Network Senior |
$36.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.48
|
| Rate for Payer: Multiplan Commercial |
$44.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.70
|
| Rate for Payer: TriValley Medical Group Senior |
$23.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.36
|
| Rate for Payer: Vantage Medical Group Senior |
$50.36
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$59.25
|
|
|
Service Code
|
NDC 0904714904
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$44.44 |
| Rate for Payer: Adventist Health Commercial |
$11.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.16
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.11
|
| Rate for Payer: Heritage Provider Network Senior |
$40.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.81
|
| Rate for Payer: Multiplan Commercial |
$44.44
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 0527213335
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.22
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 7231902302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 7231902302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.80
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
OP
|
$36.21
|
|
|
Service Code
|
HCPCS J1837
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Adventist Health Commercial |
$7.24
|
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$11.83
|
| Rate for Payer: Blue Shield of California Commercial |
$22.09
|
| Rate for Payer: Blue Shield of California Commercial |
$23.25
|
| Rate for Payer: Blue Shield of California EPN |
$18.60
|
| Rate for Payer: Blue Shield of California EPN |
$9.47
|
| Rate for Payer: Blue Shield of California EPN |
$17.67
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.98
|
| Rate for Payer: Heritage Provider Network Senior |
$16.77
|
| Rate for Payer: Heritage Provider Network Senior |
$8.98
|
| Rate for Payer: Heritage Provider Network Senior |
$17.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
| Rate for Payer: Multiplan Commercial |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$14.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.48
|
| Rate for Payer: TriValley Medical Group Senior |
$15.25
|
| Rate for Payer: TriValley Medical Group Senior |
$7.76
|
| Rate for Payer: TriValley Medical Group Senior |
$14.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
IP
|
$38.12
|
|
|
Service Code
|
HCPCS J1837
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$28.59 |
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Adventist Health Commercial |
$7.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.49
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.77
|
| Rate for Payer: Heritage Provider Network Senior |
$16.77
|
| Rate for Payer: Heritage Provider Network Senior |
$8.98
|
| Rate for Payer: Heritage Provider Network Senior |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.99
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$28,705.37
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$21,421.92 |
| Max. Negotiated Rate |
$28,705.37 |
| Rate for Payer: EPIC Health Plan Medicare |
$21,421.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,421.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,635.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,705.37
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$16,024.82
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$11,958.82 |
| Max. Negotiated Rate |
$16,024.82 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,958.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,958.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,752.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,024.82
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$33,585.32
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$25,063.67 |
| Max. Negotiated Rate |
$33,585.32 |
| Rate for Payer: EPIC Health Plan Medicare |
$25,063.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,063.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,823.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,585.32
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$70,549.00
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$52,648.51 |
| Max. Negotiated Rate |
$70,549.00 |
| Rate for Payer: EPIC Health Plan Medicare |
$52,648.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$52,648.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60,545.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70,549.00
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,090.22
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$16,485.24 |
| Max. Negotiated Rate |
$22,090.22 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,485.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,485.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,958.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,090.22
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$26,649.26
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$19,887.51 |
| Max. Negotiated Rate |
$26,649.26 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,887.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,887.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,870.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,649.26
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$10,754.80
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$8,025.97 |
| Max. Negotiated Rate |
$10,754.80 |
| Rate for Payer: EPIC Health Plan Medicare |
$8,025.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,025.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,229.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,754.80
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION [6420]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
POTASSIUM ACETATE ORAL SOLUTION (IV FORM) 2 MEQ/ML [4080437]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 9994080437
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$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: Multiplan Commercial |
$0.02
|
|
|
POTASSIUM ACETATE ORAL SOLUTION (IV FORM) 2 MEQ/ML [4080437]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 9994080437
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| 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: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
|
POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID [6432]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 8103341215
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
|
