|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 7985404112
|
| Hospital Charge Code |
1712537
|
|
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 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
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 5026886511
|
| Hospital Charge Code |
1712537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 8068117000
|
| Hospital Charge Code |
1712537
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 7985404112
|
| Hospital Charge Code |
1712537
|
|
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 |
$0.04
|
| 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: 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: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 8068117000
|
| Hospital Charge Code |
1712537
|
|
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 |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET [94284]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 8770140751
|
| Hospital Charge Code |
1712537
|
|
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: 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: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$12,004.42
|
|
|
Service Code
|
APR-DRG 2632
|
| Min. Negotiated Rate |
$12,004.42 |
| Max. Negotiated Rate |
$12,004.42 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,004.42
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$28,105.81
|
|
|
Service Code
|
APR-DRG 2634
|
| Min. Negotiated Rate |
$28,105.81 |
| Max. Negotiated Rate |
$28,105.81 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28,105.81
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$9,470.41
|
|
|
Service Code
|
APR-DRG 2631
|
| Min. Negotiated Rate |
$9,470.41 |
| Max. Negotiated Rate |
$9,470.41 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,470.41
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$15,229.87
|
|
|
Service Code
|
APR-DRG 2633
|
| Min. Negotiated Rate |
$15,229.87 |
| Max. Negotiated Rate |
$15,229.87 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,229.87
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 67877-298-09
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Senior |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 49884-465-64
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Senior |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 49884-465-65
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Senior |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2.09
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 49884-465-64
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.69
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 67877-298-60
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Senior |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 67877-298-60
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Senior |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Senior |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 49884-465-65
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.69
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 67877-298-09
|
| Hospital Charge Code |
1713081
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Senior |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Senior |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.35 ML)1 %(0.4 ML)INTRAOCULAR SYRING [28916]
|
Facility
|
OP
|
$378.13
|
|
|
Service Code
|
NDC 8065183135
|
| Hospital Charge Code |
NDG28916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.44 |
| Max. Negotiated Rate |
$321.41 |
| Rate for Payer: Adventist Health Commercial |
$75.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$321.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.60
|
| Rate for Payer: Blue Shield of California Commercial |
$234.82
|
| Rate for Payer: Blue Shield of California EPN |
$221.96
|
| Rate for Payer: Cash Price |
$170.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$321.41
|
| Rate for Payer: Dignity Health Senior |
$321.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.06
|
| Rate for Payer: Heritage Provider Network Senior |
$234.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$182.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.53
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.25
|
| Rate for Payer: TriValley Medical Group Senior |
$151.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$321.41
|
| Rate for Payer: Vantage Medical Group Senior |
$321.41
|
|
|
CHONDROITIN-SOD HYALURON 3 %-4 %(0.35 ML)1 %(0.4 ML)INTRAOCULAR SYRING [28916]
|
Facility
|
IP
|
$378.13
|
|
|
Service Code
|
NDC 8065183135
|
| Hospital Charge Code |
NDG28916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.44 |
| Max. Negotiated Rate |
$283.60 |
| Rate for Payer: Adventist Health Commercial |
$75.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.78
|
| Rate for Payer: Cash Price |
$170.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.99
|
| Rate for Payer: Heritage Provider Network Senior |
$255.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.53
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE [28923]
|
Facility
|
IP
|
$431.64
|
|
|
Service Code
|
NDC 8065183905
|
| Hospital Charge Code |
1720965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.13 |
| Max. Negotiated Rate |
$323.73 |
| Rate for Payer: Adventist Health Commercial |
$86.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.54
|
| Rate for Payer: Cash Price |
$194.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.22
|
| Rate for Payer: Heritage Provider Network Senior |
$292.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.91
|
| Rate for Payer: Multiplan Commercial |
$323.73
|
|
|
CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE [28923]
|
Facility
|
OP
|
$431.64
|
|
|
Service Code
|
NDC 8065183905
|
| Hospital Charge Code |
1720965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.13 |
| Max. Negotiated Rate |
$366.89 |
| Rate for Payer: Adventist Health Commercial |
$86.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$230.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$366.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$237.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.73
|
| Rate for Payer: Blue Shield of California Commercial |
$268.05
|
| Rate for Payer: Blue Shield of California EPN |
$253.37
|
| Rate for Payer: Cash Price |
$194.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$280.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$366.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$366.89
|
| Rate for Payer: Dignity Health Senior |
$366.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$267.19
|
| Rate for Payer: Heritage Provider Network Senior |
$267.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$208.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.91
|
| Rate for Payer: Multiplan Commercial |
$323.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$366.89
|
| Rate for Payer: Vantage Medical Group Senior |
$366.89
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION [1685]
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
NDC 0409-4093-01
|
| Hospital Charge Code |
1757538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.02
|
| Rate for Payer: Dignity Health Senior |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Senior |
$0.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.02
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION [1685]
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 0409-4093-01
|
| Hospital Charge Code |
1757538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.64
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
|
|
Chromotubation of oviduct, including materials
|
Facility
|
OP
|
$11,807.68
|
|
|
Service Code
|
CPT 58350
|
| Min. Negotiated Rate |
$226.08 |
| Max. Negotiated Rate |
$11,807.68 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,836.03
|
| Rate for Payer: Dignity Health Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,214.57
|
| Rate for Payer: Humana Medicare |
$6,214.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,214.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,807.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,333.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,830.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,830.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,836.03
|
| Rate for Payer: TriValley Medical Group Senior |
$6,214.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
