|
STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
NDC 62327-444-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$175.95 |
| Rate for Payer: Adventist Health Commercial |
$46.92
|
| Rate for Payer: Cash Price |
$129.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$158.82
|
| Rate for Payer: Heritage Provider Network Senior |
$158.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.65
|
| Rate for Payer: Multiplan Commercial |
$175.95
|
|
|
STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
NDC 62327-444-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$199.41 |
| Rate for Payer: Adventist Health Commercial |
$46.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$125.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.95
|
| Rate for Payer: Blue Shield of California Commercial |
$143.11
|
| Rate for Payer: Blue Shield of California EPN |
$114.48
|
| Rate for Payer: Cash Price |
$129.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.41
|
| Rate for Payer: Dignity Health Senior |
$199.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.22
|
| Rate for Payer: Heritage Provider Network Senior |
$145.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$111.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.22
|
| Rate for Payer: Multiplan Commercial |
$175.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$93.84
|
| Rate for Payer: TriValley Medical Group Senior |
$93.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$117.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$117.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.41
|
| Rate for Payer: Vantage Medical Group Senior |
$199.41
|
|
|
STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
NDC 62327-444-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$175.95 |
| Rate for Payer: Adventist Health Commercial |
$46.92
|
| Rate for Payer: Cash Price |
$129.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$158.82
|
| Rate for Payer: Heritage Provider Network Senior |
$158.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.65
|
| Rate for Payer: Multiplan Commercial |
$175.95
|
|
|
STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION [221295]
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
NDC 62327-444-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$199.41 |
| Rate for Payer: Adventist Health Commercial |
$46.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$125.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.95
|
| Rate for Payer: Blue Shield of California Commercial |
$143.11
|
| Rate for Payer: Blue Shield of California EPN |
$114.48
|
| Rate for Payer: Cash Price |
$129.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.41
|
| Rate for Payer: Dignity Health Senior |
$199.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.22
|
| Rate for Payer: Heritage Provider Network Senior |
$145.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$111.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.22
|
| Rate for Payer: Multiplan Commercial |
$175.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$93.84
|
| Rate for Payer: TriValley Medical Group Senior |
$93.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$117.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$117.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.41
|
| Rate for Payer: Vantage Medical Group Senior |
$199.41
|
|
|
STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION [37812]
|
Facility
|
OP
|
$119.40
|
|
|
Service Code
|
NDC 63256-200-05
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$101.49 |
| Rate for Payer: Adventist Health Commercial |
$23.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.55
|
| Rate for Payer: Blue Shield of California Commercial |
$72.83
|
| Rate for Payer: Blue Shield of California EPN |
$58.27
|
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.49
|
| Rate for Payer: Dignity Health Senior |
$101.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.91
|
| Rate for Payer: Heritage Provider Network Senior |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.58
|
| Rate for Payer: Multiplan Commercial |
$89.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.76
|
| Rate for Payer: TriValley Medical Group Senior |
$47.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.49
|
| Rate for Payer: Vantage Medical Group Senior |
$101.49
|
|
|
STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION [37812]
|
Facility
|
IP
|
$119.40
|
|
|
Service Code
|
NDC 63256-200-05
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$89.55 |
| Rate for Payer: Adventist Health Commercial |
$23.88
|
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.83
|
| Rate for Payer: Heritage Provider Network Senior |
$80.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.85
|
| Rate for Payer: Multiplan Commercial |
$89.55
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0409-3977-03
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Senior |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| 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 Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0264-7850-20
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
HCPCS A4216
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS A4216
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.35
|
| Rate for Payer: Dignity Health Senior |
$0.33
|
| Rate for Payer: Dignity Health Senior |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| 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 Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 0409-3977-03
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0264-7850-20
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Senior |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7850-10
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7850-10
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7850-00
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
STERILE WATER FOR INJECTION. [4081186]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 0264-7850-00
|
| Hospital Charge Code |
901700008
|
|
Hospital Revenue Code
|
258
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
|
|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$202.34 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.34
|
| Rate for Payer: Blue Shield of California Commercial |
$79.69
|
| Rate for Payer: Blue Shield of California EPN |
$79.69
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Senior |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
SUCCIMER 100 MG CAPSULE [11438]
|
Facility
|
OP
|
$26.44
|
|
|
Service Code
|
NDC 55292-201-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.83
|
| Rate for Payer: Blue Shield of California Commercial |
$16.13
|
| Rate for Payer: Blue Shield of California EPN |
$12.90
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.47
|
| Rate for Payer: Dignity Health Senior |
$22.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.37
|
| Rate for Payer: Heritage Provider Network Senior |
$16.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.51
|
| Rate for Payer: Multiplan Commercial |
$19.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.58
|
| Rate for Payer: TriValley Medical Group Senior |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.47
|
| Rate for Payer: Vantage Medical Group Senior |
$22.47
|
|
|
SUCCIMER 100 MG CAPSULE [11438]
|
Facility
|
IP
|
$26.44
|
|
|
Service Code
|
NDC 55292-201-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.90
|
| Rate for Payer: Heritage Provider Network Senior |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$19.83
|
|
|
SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) INTRAVENOUS SYRINGE [121307]
|
Facility
|
OP
|
$5.15
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.38
|
| Rate for Payer: Dignity Health Senior |
$3.09
|
| Rate for Payer: Dignity Health Senior |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.45
|
| Rate for Payer: TriValley Medical Group Senior |
$1.45
|
| Rate for Payer: TriValley Medical Group Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3.09
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) INTRAVENOUS SYRINGE [121307]
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.73
|
| Rate for Payer: Adventist Health Commercial |
$1.03
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$2.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
|
|
SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML INJECTION VIAL - CODE [4087536]
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.77
|
|
|
SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML INJECTION VIAL - CODE [4087536]
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.98
|
| Rate for Payer: Dignity Health Senior |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.93
|
| Rate for Payer: TriValley Medical Group Senior |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1.98
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [7536]
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.87
|
| Rate for Payer: Dignity Health Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Vantage Medical Group Senior |
$0.87
|
|
