|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
IP
|
$16.99
|
|
|
Service Code
|
NDC 62756-071-60
|
| Hospital Charge Code |
ERX89791
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.67
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
IP
|
$20.83
|
|
|
Service Code
|
NDC 0008-0844-02
|
| Hospital Charge Code |
ERX89791
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$15.62 |
| Rate for Payer: Adventist Health Commercial |
$4.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.31
|
| Rate for Payer: Cash Price |
$9.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.10
|
| Rate for Payer: Heritage Provider Network Senior |
$14.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$15.62
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
IP
|
$16.99
|
|
|
Service Code
|
NDC 62756-071-64
|
| Hospital Charge Code |
ERX89791
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.67
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
|
|
PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET [89791]
|
Facility
IP
|
$20.83
|
|
|
Service Code
|
NDC 0008-0844-01
|
| Hospital Charge Code |
ERX89791
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$15.62 |
| Rate for Payer: Adventist Health Commercial |
$4.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.31
|
| Rate for Payer: Cash Price |
$9.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.10
|
| Rate for Payer: Heritage Provider Network Senior |
$14.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Multiplan Commercial |
$15.62
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]
|
Facility
IP
|
$19.50
|
|
|
Service Code
|
CPT J2440
|
| Hospital Charge Code |
NDG6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Adventist Health Commercial |
$4.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.07
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.82
|
| Rate for Payer: Heritage Provider Network Senior |
$15.79
|
| Rate for Payer: Heritage Provider Network Senior |
$13.20
|
| Rate for Payer: Heritage Provider Network Senior |
$15.23
|
| Rate for Payer: Heritage Provider Network Senior |
$16.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.79
|
|
|
PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]
|
Facility
OP
|
$22.50
|
|
|
Service Code
|
CPT J2440
|
| Hospital Charge Code |
NDG6030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$90.85 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Adventist Health Commercial |
$4.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$38.25
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cash Price |
$10.49
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.58
|
| Rate for Payer: Dignity Health Senior |
$19.12
|
| Rate for Payer: Dignity Health Senior |
$19.82
|
| Rate for Payer: Dignity Health Senior |
$16.58
|
| Rate for Payer: Dignity Health Senior |
$21.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.03
|
| Rate for Payer: Heritage Provider Network Senior |
$11.51
|
| Rate for Payer: Heritage Provider Network Senior |
$10.80
|
| Rate for Payer: Heritage Provider Network Senior |
$10.42
|
| Rate for Payer: Heritage Provider Network Senior |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$17.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.82
|
| Rate for Payer: Vantage Medical Group Senior |
$21.12
|
| Rate for Payer: Vantage Medical Group Senior |
$19.12
|
| Rate for Payer: Vantage Medical Group Senior |
$16.58
|
| Rate for Payer: Vantage Medical Group Senior |
$19.82
|
|
|
Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous
|
Facility
OP
|
$5,532.10
|
|
|
Service Code
|
CPT 65800
|
| Min. Negotiated Rate |
$122.55 |
| Max. Negotiated Rate |
$5,532.10 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$122.55
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection
|
Facility
OP
|
$5,532.10
|
|
|
Service Code
|
CPT 65815
|
| Min. Negotiated Rate |
$355.45 |
| Max. Negotiated Rate |
$5,532.10 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$355.45
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Parathyroid autotransplantation (List separately in addition to code for primary procedure)
|
Facility
OP
|
$4,547.00
|
|
|
Service Code
|
CPT 60512
|
| Min. Negotiated Rate |
$63.30 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: IEHP Medi-Cal |
$63.30
|
|
|
Parathyroidectomy or exploration of parathyroid(s);
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 60500
|
| Min. Negotiated Rate |
$1,184.23 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$1,184.23
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,048.59
|
| Rate for Payer: TriValley Medical Group Senior |
$7,316.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Paravaginal defect repair (including repair of cystocele, if performed); vaginal approach
|
Facility
OP
|
$17,938.64
|
|
|
Service Code
|
CPT 57285
|
| Min. Negotiated Rate |
$778.60 |
| Max. Negotiated Rate |
$17,938.64 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,162.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,385.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,441.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,162.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,385.53
|
| Rate for Payer: Dignity Health Senior |
$9,441.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,441.39
|
| Rate for Payer: Humana Medicare |
$9,441.39
|
| Rate for Payer: IEHP Medi-Cal |
$778.60
|
| Rate for Payer: IEHP Medicare Advantage |
$9,441.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,938.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,140.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,896.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,896.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,385.53
|
| Rate for Payer: TriValley Medical Group Senior |
$9,441.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,162.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,385.53
|
| Rate for Payer: Vantage Medical Group Senior |
$9,441.39
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION [222465]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 0338-0502-06
|
| Hospital Charge Code |
NDG222465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$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 |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION [222465]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 0338-0502-06
|
| Hospital Charge Code |
NDG222465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| 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 |
$0.06
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.6 INTRAVENOUS SOLUTION [224619]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 0264-4500-00
|
| Hospital Charge Code |
NDG119537B
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
PARENTERAL AMINO ACID 15 % COMBINATION NO.6 INTRAVENOUS SOLUTION [224619]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 0264-4500-00
|
| Hospital Charge Code |
NDG119537B
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
IP
|
$1.20
|
|
|
Service Code
|
NDC 49483-687-03
|
| Hospital Charge Code |
1712296
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
IP
|
$1.78
|
|
|
Service Code
|
NDC 65862-936-30
|
| Hospital Charge Code |
1712296
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.22
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
OP
|
$1.78
|
|
|
Service Code
|
NDC 65862-936-30
|
| Hospital Charge Code |
1712296
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.51
|
| Rate for Payer: Dignity Health Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
PARICALCITOL 1 MCG CAPSULE [41497]
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
NDC 49483-687-03
|
| Hospital Charge Code |
1712296
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Senior |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
NDC 69452-146-13
|
| Hospital Charge Code |
1712331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Blue Shield of California Commercial |
$6.21
|
| Rate for Payer: Blue Shield of California EPN |
$5.87
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Senior |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
IP
|
$10.00
|
|
|
Service Code
|
NDC 69452-146-13
|
| Hospital Charge Code |
1712331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
OP
|
$3.54
|
|
|
Service Code
|
NDC 65862-937-30
|
| Hospital Charge Code |
1712331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.08
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.01
|
| Rate for Payer: Dignity Health Senior |
$3.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.19
|
| Rate for Payer: Heritage Provider Network Senior |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.01
|
| Rate for Payer: Vantage Medical Group Senior |
$3.01
|
|
|
PARICALCITOL 2 MCG CAPSULE [41498]
|
Facility
IP
|
$3.54
|
|
|
Service Code
|
NDC 65862-937-30
|
| Hospital Charge Code |
1712331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.43
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION [31688]
|
Facility
IP
|
$7.27
|
|
|
Service Code
|
CPT J2501
|
| Hospital Charge Code |
1720960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.99
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.92
|
| Rate for Payer: Heritage Provider Network Senior |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.43
|
|
|
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION [31688]
|
Facility
OP
|
$7.27
|
|
|
Service Code
|
CPT J2501
|
| Hospital Charge Code |
1720960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.18
|
| Rate for Payer: Dignity Health Senior |
$6.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3.37
|
| Rate for Payer: IEHP Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6.18
|
|
