|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$35,587.68
|
|
|
Service Code
|
MSDRG 085
|
| Min. Negotiated Rate |
$26,557.97 |
| Max. Negotiated Rate |
$35,587.68 |
| Rate for Payer: EPIC Health Plan Medicare |
$26,557.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,557.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,541.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,587.68
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$35,798.03
|
|
|
Service Code
|
MSDRG 082
|
| Min. Negotiated Rate |
$26,714.95 |
| Max. Negotiated Rate |
$35,798.03 |
| Rate for Payer: EPIC Health Plan Medicare |
$26,714.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,714.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,722.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,798.03
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$14,747.24
|
|
|
Service Code
|
MSDRG 087
|
| Min. Negotiated Rate |
$11,005.40 |
| Max. Negotiated Rate |
$14,747.24 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,005.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,005.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,656.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,747.24
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$15,378.36
|
|
|
Service Code
|
MSDRG 084
|
| Min. Negotiated Rate |
$11,476.39 |
| Max. Negotiated Rate |
$15,378.36 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,476.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,476.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,197.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,378.36
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$23,306.39
|
|
|
Service Code
|
MSDRG 604
|
| Min. Negotiated Rate |
$17,392.83 |
| Max. Negotiated Rate |
$23,306.39 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,392.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,392.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,001.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,306.39
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$14,767.23
|
|
|
Service Code
|
MSDRG 605
|
| Min. Negotiated Rate |
$11,020.32 |
| Max. Negotiated Rate |
$14,767.23 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,020.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,020.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,673.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,767.23
|
|
|
TRAVOPROST 0.004 % EYE DROPS [110762]
|
Facility
|
OP
|
$60.36
|
|
|
Service Code
|
NDC 6050505934
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Adventist Health Commercial |
$12.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.19
|
| Rate for Payer: Blue Shield of California Commercial |
$36.82
|
| Rate for Payer: Blue Shield of California EPN |
$29.46
|
| Rate for Payer: Cash Price |
$27.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.36
|
| Rate for Payer: Heritage Provider Network Senior |
$37.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$45.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.14
|
| Rate for Payer: TriValley Medical Group Senior |
$24.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
TRAVOPROST 0.004 % EYE DROPS [110762]
|
Facility
|
IP
|
$76.17
|
|
|
Service Code
|
NDC 0378965132
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$57.13 |
| Rate for Payer: Adventist Health Commercial |
$15.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.05
|
| Rate for Payer: Cash Price |
$34.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.57
|
| Rate for Payer: Heritage Provider Network Senior |
$51.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.04
|
| Rate for Payer: Multiplan Commercial |
$57.13
|
|
|
TRAVOPROST 0.004 % EYE DROPS [110762]
|
Facility
|
OP
|
$76.17
|
|
|
Service Code
|
NDC 0378965132
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$64.74 |
| Rate for Payer: Adventist Health Commercial |
$15.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.10
|
| Rate for Payer: Blue Shield of California Commercial |
$46.46
|
| Rate for Payer: Blue Shield of California EPN |
$37.17
|
| Rate for Payer: Cash Price |
$34.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.15
|
| Rate for Payer: Heritage Provider Network Senior |
$47.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.32
|
| Rate for Payer: Multiplan Commercial |
$57.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.47
|
| Rate for Payer: TriValley Medical Group Senior |
$30.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.74
|
| Rate for Payer: Vantage Medical Group Senior |
$64.74
|
|
|
TRAVOPROST 0.004 % EYE DROPS [110762]
|
Facility
|
IP
|
$60.36
|
|
|
Service Code
|
NDC 6050505934
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$45.27 |
| Rate for Payer: Adventist Health Commercial |
$12.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.87
|
| Rate for Payer: Cash Price |
$27.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.86
|
| Rate for Payer: Heritage Provider Network Senior |
$40.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$45.27
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 7001023201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6068745411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 6068745401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6068745401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 6068745411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 7001023201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 5011156101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
TRAZODONE 100 MG TABLET [8083]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 5011156101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
TRAZODONE 150 MG TABLET [8084]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 6808460801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
TRAZODONE 150 MG TABLET [8084]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 6838280701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.21
|
| 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: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
TRAZODONE 150 MG TABLET [8084]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 6838280701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
|
|
TRAZODONE 150 MG TABLET [8084]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
NDC 5348951701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
TRAZODONE 150 MG TABLET [8084]
|
Facility
|
IP
|
$0.43
|
|
|
Service Code
|
NDC 5348951701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Senior |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
|
|
TRAZODONE 150 MG TABLET [8084]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 6068743211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Vantage Medical Group Senior |
$0.59
|
|
|
TRAZODONE 150 MG TABLET [8084]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 6068743211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.52
|
|
