|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$3,200.58
|
|
|
Service Code
|
APR-DRG 8441
|
| Min. Negotiated Rate |
$3,200.58 |
| Max. Negotiated Rate |
$3,200.58 |
| Rate for Payer: IEHP Medi-Cal |
$3,200.58
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$8,912.28
|
|
|
Service Code
|
APR-DRG 8443
|
| Min. Negotiated Rate |
$8,912.28 |
| Max. Negotiated Rate |
$8,912.28 |
| Rate for Payer: IEHP Medi-Cal |
$8,912.28
|
|
|
Partial thyroid lobectomy, unilateral; with or without isthmusectomy
|
Facility
OP
|
$13,697.50
|
|
|
Service Code
|
CPT 60210
|
| Min. Negotiated Rate |
$175.98 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: IEHP Medi-Cal |
$175.98
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,209.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]
|
Facility
IP
|
$39.60
|
|
|
Service Code
|
NDC 53436-168-01
|
| Hospital Charge Code |
ERX211786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.81
|
| Rate for Payer: Heritage Provider Network Senior |
$26.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
|
|
PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]
|
Facility
OP
|
$39.60
|
|
|
Service Code
|
NDC 53436-168-01
|
| Hospital Charge Code |
ERX211786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.70
|
| Rate for Payer: Blue Shield of California Commercial |
$24.59
|
| Rate for Payer: Blue Shield of California EPN |
$23.25
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.66
|
| Rate for Payer: Dignity Health Senior |
$33.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.66
|
| Rate for Payer: Vantage Medical Group Senior |
$33.66
|
|
|
PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]
|
Facility
IP
|
$39.60
|
|
|
Service Code
|
NDC 53436-168-30
|
| Hospital Charge Code |
ERX211786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.81
|
| Rate for Payer: Heritage Provider Network Senior |
$26.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
|
|
PATIROMER CALCIUM SORBITEX 16.8 GRAM ORAL POWDER PACKET [211786]
|
Facility
OP
|
$39.60
|
|
|
Service Code
|
NDC 53436-168-30
|
| Hospital Charge Code |
ERX211786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.70
|
| Rate for Payer: Blue Shield of California Commercial |
$24.59
|
| Rate for Payer: Blue Shield of California EPN |
$23.25
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.66
|
| Rate for Payer: Dignity Health Senior |
$33.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.66
|
| Rate for Payer: Vantage Medical Group Senior |
$33.66
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]
|
Facility
IP
|
$39.60
|
|
|
Service Code
|
NDC 53436-084-30
|
| Hospital Charge Code |
ERX211785
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.81
|
| Rate for Payer: Heritage Provider Network Senior |
$26.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]
|
Facility
OP
|
$39.60
|
|
|
Service Code
|
NDC 53436-084-01
|
| Hospital Charge Code |
ERX211785
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.70
|
| Rate for Payer: Blue Shield of California Commercial |
$24.59
|
| Rate for Payer: Blue Shield of California EPN |
$23.25
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.66
|
| Rate for Payer: Dignity Health Senior |
$33.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.66
|
| Rate for Payer: Vantage Medical Group Senior |
$33.66
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]
|
Facility
OP
|
$39.60
|
|
|
Service Code
|
NDC 53436-084-30
|
| Hospital Charge Code |
ERX211785
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.70
|
| Rate for Payer: Blue Shield of California Commercial |
$24.59
|
| Rate for Payer: Blue Shield of California EPN |
$23.25
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.66
|
| Rate for Payer: Dignity Health Senior |
$33.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.66
|
| Rate for Payer: Vantage Medical Group Senior |
$33.66
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET [211785]
|
Facility
IP
|
$39.60
|
|
|
Service Code
|
NDC 53436-084-01
|
| Hospital Charge Code |
ERX211785
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.81
|
| Rate for Payer: Heritage Provider Network Senior |
$26.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
|
|
PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS [228315]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 87040203
|
| Hospital Charge Code |
1715260
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
|
|
PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG-10 MCG/ML ORAL DROPS [228315]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
NDC 87040203
|
| Hospital Charge Code |
1715260
|
|
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 Gatekeeper |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Senior |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
PEDIATRIC MULTIVITAMIN NO.40-PHYTONADIONE 400 MCG/ML ORAL DROPS [118399]
|
Facility
OP
|
$0.42
|
|
|
Service Code
|
NDC 5891421460
|
| Hospital Charge Code |
NDG118399
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
PEDIATRIC MULTIVITAMIN NO.40-PHYTONADIONE 400 MCG/ML ORAL DROPS [118399]
|
Facility
IP
|
$0.42
|
|
|
Service Code
|
NDC 5891421460
|
| Hospital Charge Code |
NDG118399
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
|
|
PEDIATRIC MULTIVITAMIN NO.61-VIT D3 3,000 UNIT-VIT K 800 MCG CAPSULE [206186]
|
Facility
OP
|
$0.66
|
|
|
Service Code
|
NDC 5820400406
|
| Hospital Charge Code |
ERX206186
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Senior |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
PEDIATRIC MULTIVITAMIN NO.61-VIT D3 3,000 UNIT-VIT K 800 MCG CAPSULE [206186]
|
Facility
IP
|
$0.66
|
|
|
Service Code
|
NDC 5820400406
|
| Hospital Charge Code |
ERX206186
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
|
|
PEDI NUTRITION WITH IRON LACTOSE-FREE 0.03 GRAM-1 KCAL/ML ORAL LIQUID [120893]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 4390033511
|
| Hospital Charge Code |
NDG120893
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PEDI NUTRITION WITH IRON LACTOSE-FREE 0.03 GRAM-1 KCAL/ML ORAL LIQUID [120893]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 4390033511
|
| Hospital Charge Code |
NDG120893
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 52268-100-01
|
| Hospital Charge Code |
1713013
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 52268-100-01
|
| Hospital Charge Code |
1713013
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 64380-766-21
|
| Hospital Charge Code |
1713013
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 43386-090-19
|
| Hospital Charge Code |
1713013
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 43386-090-19
|
| Hospital Charge Code |
1713013
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 64380-766-21
|
| Hospital Charge Code |
1713013
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Senior |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
