|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 16729-145-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 67877-242-01
|
| 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 Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| 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 |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| 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 |
$0.02
|
| 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
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 67877-242-01
|
| 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: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
| Rate for Payer: Dignity Health Senior |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 47335-902-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 47335-902-88
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
| Rate for Payer: Dignity Health Senior |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 68180-445-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 16729-145-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Senior |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 68180-445-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]
|
Facility
|
IP
|
$8.70
|
|
|
Service Code
|
NDC 53489-141-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]
|
Facility
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 53489-141-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.39
|
| Rate for Payer: Dignity Health Senior |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.09
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.39
|
| Rate for Payer: Vantage Medical Group Senior |
$7.39
|
|
|
QUININE 324 MG CAPSULE [117183]
|
Facility
|
IP
|
$7.86
|
|
|
Service Code
|
NDC 13310-153-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.32
|
| Rate for Payer: Heritage Provider Network Senior |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$5.89
|
|
|
QUININE 324 MG CAPSULE [117183]
|
Facility
|
OP
|
$7.86
|
|
|
Service Code
|
NDC 13310-153-07
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.89
|
| Rate for Payer: Blue Shield of California Commercial |
$4.79
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.68
|
| Rate for Payer: Dignity Health Senior |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$5.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.14
|
| Rate for Payer: TriValley Medical Group Senior |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]
|
Facility
|
IP
|
$447.37
|
|
|
Service Code
|
HCPCS 90377
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.97 |
| Max. Negotiated Rate |
$335.53 |
| Rate for Payer: Adventist Health Commercial |
$89.47
|
| Rate for Payer: Cash Price |
$246.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$205.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.13
|
| Rate for Payer: Heritage Provider Network Senior |
$207.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.84
|
| Rate for Payer: Multiplan Commercial |
$335.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$148.12
|
|
|
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]
|
Facility
|
OP
|
$447.37
|
|
|
Service Code
|
HCPCS 90377
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.97 |
| Max. Negotiated Rate |
$335.53 |
| Rate for Payer: Adventist Health Commercial |
$89.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$239.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$307.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.81
|
| Rate for Payer: Blue Shield of California Commercial |
$272.90
|
| Rate for Payer: Blue Shield of California EPN |
$218.32
|
| Rate for Payer: Cash Price |
$246.05
|
| Rate for Payer: Cash Price |
$246.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$205.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.81
|
| Rate for Payer: Dignity Health Senior |
$260.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$237.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.13
|
| Rate for Payer: Heritage Provider Network Senior |
$207.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$237.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$213.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.75
|
| Rate for Payer: Multiplan Commercial |
$335.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$178.95
|
| Rate for Payer: TriValley Medical Group Senior |
$178.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$148.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.81
|
| Rate for Payer: Vantage Medical Group Senior |
$260.81
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
IP
|
$816.60
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$612.45 |
| Rate for Payer: Adventist Health Commercial |
$163.32
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.09
|
| Rate for Payer: Heritage Provider Network Senior |
$378.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.15
|
| Rate for Payer: Multiplan Commercial |
$612.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$295.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$270.38
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
OP
|
$816.60
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$868.20 |
| Rate for Payer: Adventist Health Commercial |
$163.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$436.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$561.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$333.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$293.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$868.20
|
| Rate for Payer: Blue Shield of California Commercial |
$341.92
|
| Rate for Payer: Blue Shield of California EPN |
$341.92
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$333.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.08
|
| Rate for Payer: Dignity Health Senior |
$293.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.09
|
| Rate for Payer: Heritage Provider Network Senior |
$378.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$289.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$389.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.71
|
| Rate for Payer: Multiplan Commercial |
$612.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$326.64
|
| Rate for Payer: TriValley Medical Group Senior |
$326.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$295.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$270.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$333.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.08
|
| Rate for Payer: Vantage Medical Group Senior |
$293.08
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
OP
|
$520.57
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.22 |
| Max. Negotiated Rate |
$1,072.01 |
| Rate for Payer: Adventist Health Commercial |
$104.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$278.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$357.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$343.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.01
|
| Rate for Payer: Blue Shield of California Commercial |
$422.19
|
| Rate for Payer: Blue Shield of California EPN |
$422.19
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.23
|
| Rate for Payer: Dignity Health Senior |
$343.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$312.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.02
|
| Rate for Payer: Heritage Provider Network Senior |
$241.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$317.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$312.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$248.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$358.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$393.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$393.16
|
| Rate for Payer: Multiplan Commercial |
$390.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$208.23
|
| Rate for Payer: TriValley Medical Group Senior |
$208.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$172.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.23
|
| Rate for Payer: Vantage Medical Group Senior |
$343.23
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
|
IP
|
$520.57
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.22 |
| Max. Negotiated Rate |
$390.43 |
| Rate for Payer: Adventist Health Commercial |
$104.11
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.02
|
| Rate for Payer: Heritage Provider Network Senior |
$241.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.14
|
| Rate for Payer: Multiplan Commercial |
$390.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$172.36
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
|
IP
|
$521.53
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$391.15 |
| Rate for Payer: Adventist Health Commercial |
$104.31
|
| Rate for Payer: Cash Price |
$286.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.47
|
| Rate for Payer: Heritage Provider Network Senior |
$241.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.38
|
| Rate for Payer: Multiplan Commercial |
$391.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$172.68
|
|
