|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 6068732711
|
| 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: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Cash Price |
$0.18
|
| 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 Foundation Hospitals 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
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 6787724201
|
| 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 |
$0.03
|
| 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 Foundation Hospitals 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
|
$0.11
|
|
|
Service Code
|
NDC 2930014701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 4733590288
|
| 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: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| 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 Foundation Hospitals 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
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 6068732701
|
| 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 Non-Gatekeeper |
$0.24
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| 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 |
$0.18
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 1672914501
|
| 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 Non-Gatekeeper |
$0.04
|
| 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 Foundation Hospitals 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
|
$0.35
|
|
|
Service Code
|
NDC 0904663861
|
| 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: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Cash Price |
$0.16
|
| 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 Foundation Hospitals 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
|
$0.39
|
|
|
Service Code
|
NDC 6068732701
|
| 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: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Cash Price |
$0.18
|
| 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 Foundation Hospitals 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
|
$0.06
|
|
|
Service Code
|
NDC 1672914501
|
| 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 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: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| 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
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 4733590288
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| 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 |
$0.10
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$0.11
|
|
|
Service Code
|
NDC 2930014701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 6818044501
|
| 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 Non-Gatekeeper |
$0.04
|
| 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 Foundation Hospitals 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
|
$0.06
|
|
|
Service Code
|
NDC 6818044501
|
| 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 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: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.04
|
| 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
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 5348914101
|
| 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 Non-Gatekeeper |
$5.38
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| 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 |
$3.91
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]
|
Facility
|
IP
|
$8.70
|
|
|
Service Code
|
NDC 5348914101
|
| 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: Aetna of CA Non-Gatekeeper |
$5.60
|
| Rate for Payer: Cash Price |
$3.91
|
| 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 Foundation Hospitals Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
|
|
QUINIDINE SULFATE 200 MG TABLET [6777]
|
Facility
|
OP
|
$14.48
|
|
|
Service Code
|
NDC 4280651330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$12.31 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8.83
|
| Rate for Payer: Blue Shield of California EPN |
$7.07
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.96
|
| Rate for Payer: Heritage Provider Network Senior |
$8.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$10.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.79
|
| Rate for Payer: TriValley Medical Group Senior |
$5.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.31
|
| Rate for Payer: Vantage Medical Group Senior |
$12.31
|
|
|
QUINIDINE SULFATE 200 MG TABLET [6777]
|
Facility
|
IP
|
$14.48
|
|
|
Service Code
|
NDC 4280651330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.33
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.80
|
| Rate for Payer: Heritage Provider Network Senior |
$9.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$10.86
|
|
|
QUININE 324 MG CAPSULE [117183]
|
Facility
|
IP
|
$7.86
|
|
|
Service Code
|
NDC 1331015307
|
| 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: Aetna of CA Non-Gatekeeper |
$5.06
|
| Rate for Payer: Cash Price |
$3.54
|
| 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 Foundation Hospitals 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 1331015307
|
| 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 Non-Gatekeeper |
$4.86
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3.93
|
| 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 |
$3.54
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$447.37
|
|
|
Service Code
|
HCPCS 90377
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.97 |
| Max. Negotiated Rate |
$881.61 |
| Rate for Payer: Adventist Health Commercial |
$89.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$276.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$304.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$881.61
|
| 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 |
$201.32
|
| Rate for Payer: Cash Price |
$201.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$205.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$304.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$243.20
|
| 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) Medicare Advantage |
$243.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$213.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$325.89
|
| 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 |
$304.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.52
|
| Rate for Payer: Vantage Medical Group Senior |
$267.52
|
|
|
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: Aetna of CA Non-Gatekeeper |
$288.11
|
| Rate for Payer: Cash Price |
$201.32
|
| 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 Foundation Hospitals 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) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
IP
|
$832.93
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.76 |
| Max. Negotiated Rate |
$624.70 |
| Rate for Payer: Adventist Health Commercial |
$166.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$536.41
|
| Rate for Payer: Cash Price |
$374.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$383.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$385.65
|
| Rate for Payer: Heritage Provider Network Senior |
$385.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.23
|
| Rate for Payer: Multiplan Commercial |
$624.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$300.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$275.78
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
|
OP
|
$832.93
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.76 |
| Max. Negotiated Rate |
$624.70 |
| Rate for Payer: Adventist Health Commercial |
$166.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.57
|
| 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 |
$374.82
|
| Rate for Payer: Cash Price |
$374.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$383.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$385.65
|
| Rate for Payer: Heritage Provider Network Senior |
$385.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$397.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$376.79
|
| Rate for Payer: Multiplan Commercial |
$624.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$333.17
|
| Rate for Payer: TriValley Medical Group Senior |
$333.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$300.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$275.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.31
|
| Rate for Payer: Vantage Medical Group Senior |
$309.31
|
|
|
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 |
$444.85 |
| Rate for Payer: Adventist Health Commercial |
$104.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.55
|
| 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 |
$234.26
|
| Rate for Payer: Cash Price |
$234.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$331.98
|
| 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) Medicare Advantage |
$331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$248.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$444.85
|
| 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 |
$414.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.18
|
| Rate for Payer: Vantage Medical Group Senior |
$365.18
|
|
|
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: Aetna of CA Non-Gatekeeper |
$335.25
|
| Rate for Payer: Cash Price |
$234.26
|
| 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 Foundation Hospitals 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
|
|
