|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 16729-145-01
|
| Hospital Charge Code |
ERX40821823
|
|
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
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
OP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Senior |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.39
|
|
|
Service Code
|
NDC 60687-327-11
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.27
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| 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 Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 67877-242-01
|
| Hospital Charge Code |
ERX40821823
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare 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: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 16729-145-01
|
| Hospital Charge Code |
ERX40821823
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare 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: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 29300-147-01
|
| Hospital Charge Code |
ERX40821823
|
|
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 |
$0.08
|
| 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 Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
QUETIAPINE (SEROQUEL) CRUSHED TABLET IN WATER 2.5 MG/ML [40821823]
|
Facility
IP
|
$0.35
|
|
|
Service Code
|
NDC 0904-6638-61
|
| Hospital Charge Code |
ERX40821823
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.24
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]
|
Facility
OP
|
$8.70
|
|
|
Service Code
|
NDC 53489-141-01
|
| Hospital Charge Code |
1710542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California EPN |
$5.11
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.40
|
| Rate for Payer: Dignity Health Senior |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE [12197]
|
Facility
IP
|
$8.70
|
|
|
Service Code
|
NDC 53489-141-01
|
| Hospital Charge Code |
1710542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.52 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.98
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
|
|
QUINIDINE SULFATE 200 MG TABLET [6777]
|
Facility
IP
|
$0.30
|
|
|
Service Code
|
NDC 0185-4346-01
|
| Hospital Charge Code |
1710761
|
|
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 |
$0.21
|
| 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 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
|
|
|
QUINIDINE SULFATE 200 MG TABLET [6777]
|
Facility
OP
|
$0.30
|
|
|
Service Code
|
NDC 0185-4346-01
|
| Hospital Charge Code |
1710761
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare 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: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
QUININE 324 MG CAPSULE [117183]
|
Facility
OP
|
$7.86
|
|
|
Service Code
|
NDC 13310-153-07
|
| Hospital Charge Code |
1711954
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.90
|
| Rate for Payer: Blue Shield of California Commercial |
$4.88
|
| Rate for Payer: Blue Shield of California EPN |
$4.61
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.68
|
| Rate for Payer: Dignity Health Senior |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
QUININE 324 MG CAPSULE [117183]
|
Facility
IP
|
$7.86
|
|
|
Service Code
|
NDC 13310-153-07
|
| Hospital Charge Code |
1711954
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.40
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.32
|
| Rate for Payer: Heritage Provider Network Senior |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
|
|
QUINUPRISTIN-DALFOPRISTIN 500 MG INTRAVENOUS SOLUTION [26335]
|
Facility
IP
|
$559.21
|
|
|
Service Code
|
CPT J2770
|
| Hospital Charge Code |
1753511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.22 |
| Max. Negotiated Rate |
$419.41 |
| Rate for Payer: Adventist Health Commercial |
$111.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.18
|
| Rate for Payer: Cash Price |
$251.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$257.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.59
|
| Rate for Payer: Heritage Provider Network Senior |
$378.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.80
|
| Rate for Payer: Multiplan Commercial |
$419.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$203.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$186.83
|
|
|
QUINUPRISTIN-DALFOPRISTIN 500 MG INTRAVENOUS SOLUTION [26335]
|
Facility
OP
|
$559.21
|
|
|
Service Code
|
CPT J2770
|
| Hospital Charge Code |
1753511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.22 |
| Max. Negotiated Rate |
$1,128.93 |
| Rate for Payer: Adventist Health Commercial |
$111.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,128.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$617.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$543.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$543.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.62
|
| Rate for Payer: Blue Shield of California Commercial |
$475.33
|
| Rate for Payer: Blue Shield of California EPN |
$475.33
|
| Rate for Payer: Cash Price |
$251.64
|
| Rate for Payer: Cash Price |
$251.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$257.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$543.37
|
| Rate for Payer: Dignity Health Senior |
$543.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$493.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$258.91
|
| Rate for Payer: Heritage Provider Network Senior |
$258.91
|
| Rate for Payer: Humana Medicare |
$493.97
|
| Rate for Payer: IEHP Medicare Advantage |
$493.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$938.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$622.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$622.40
|
| Rate for Payer: Multiplan Commercial |
$419.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$543.37
|
| Rate for Payer: TriValley Medical Group Senior |
$493.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$203.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$186.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$740.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$543.37
|
| Rate for Payer: Vantage Medical Group Senior |
$493.97
|
|
|
R0Botic Surgery up to 2 days
|
Facility
IP
|
$10,686.00
|
|
|
Service Code
|
ICD 8E0W4CZ
|
| Min. Negotiated Rate |
$10,600.00 |
| Max. Negotiated Rate |
$10,686.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$10,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,686.00
|
|
|
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]
|
Facility
OP
|
$447.37
|
|
|
Service Code
|
CPT 90377
|
| Hospital Charge Code |
NDG111036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.97 |
| Max. Negotiated Rate |
$777.21 |
| Rate for Payer: Adventist Health Commercial |
$89.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$623.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$307.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$281.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$281.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$777.21
|
| Rate for Payer: Blue Shield of California Commercial |
$277.82
|
| Rate for Payer: Blue Shield of California EPN |
$262.61
|
| Rate for Payer: Cash Price |
$201.32
|
| Rate for Payer: Cash Price |
$201.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$205.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.94
|
| Rate for Payer: Dignity Health Senior |
$281.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$256.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.13
|
| Rate for Payer: Heritage Provider Network Senior |
$207.13
|
| Rate for Payer: Humana Medicare |
$256.30
|
| Rate for Payer: IEHP Medi-Cal |
$406.80
|
| Rate for Payer: IEHP Medicare Advantage |
$256.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$486.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.94
|
| Rate for Payer: Multiplan Commercial |
$335.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$281.94
|
| Rate for Payer: TriValley Medical Group Senior |
$256.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$163.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$149.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.94
|
| Rate for Payer: Vantage Medical Group Senior |
$256.30
|
|
|
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION [111036]
|
Facility
IP
|
$447.37
|
|
|
Service Code
|
CPT 90377
|
| Hospital Charge Code |
NDG111036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.97 |
| Max. Negotiated Rate |
$335.53 |
| Rate for Payer: Adventist Health Commercial |
$89.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$307.34
|
| Rate for Payer: Cash Price |
$201.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$205.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.87
|
| Rate for Payer: Heritage Provider Network Senior |
$302.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.84
|
| Rate for Payer: Multiplan Commercial |
$335.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$163.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$149.47
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
OP
|
$816.60
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
NDG221392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$705.32 |
| Rate for Payer: Adventist Health Commercial |
$163.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$705.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$561.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$362.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$318.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$318.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.54
|
| Rate for Payer: Blue Shield of California Commercial |
$341.92
|
| Rate for Payer: Blue Shield of California EPN |
$341.92
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$434.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.98
|
| Rate for Payer: Dignity Health Senior |
$318.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$289.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.09
|
| Rate for Payer: Heritage Provider Network Senior |
$378.09
|
| Rate for Payer: Humana Medicare |
$289.98
|
| Rate for Payer: IEHP Medi-Cal |
$459.33
|
| Rate for Payer: IEHP Medicare Advantage |
$289.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$550.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$365.37
|
| Rate for Payer: Multiplan Commercial |
$612.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$318.98
|
| Rate for Payer: TriValley Medical Group Senior |
$289.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$297.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$272.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$434.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.98
|
| Rate for Payer: Vantage Medical Group Senior |
$289.98
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION [221392]
|
Facility
IP
|
$816.60
|
|
|
Service Code
|
CPT 90375
|
| Hospital Charge Code |
NDG221392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$612.45 |
| Rate for Payer: Adventist Health Commercial |
$163.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$561.00
|
| Rate for Payer: Cash Price |
$367.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$552.84
|
| Rate for Payer: Heritage Provider Network Senior |
$552.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.15
|
| Rate for Payer: Multiplan Commercial |
$612.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$297.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$272.83
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
IP
|
$486.20
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
ERX11257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$364.65 |
| Rate for Payer: Adventist Health Commercial |
$97.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.02
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$223.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.16
|
| Rate for Payer: Heritage Provider Network Senior |
$329.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.55
|
| Rate for Payer: Multiplan Commercial |
$364.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$177.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.44
|
|
|
RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION [11257]
|
Facility
OP
|
$486.20
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
ERX11257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$789.87 |
| Rate for Payer: Adventist Health Commercial |
$97.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$789.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$405.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$357.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.68
|
| Rate for Payer: Blue Shield of California Commercial |
$386.62
|
| Rate for Payer: Blue Shield of California EPN |
$386.62
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$223.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.22
|
| Rate for Payer: Dignity Health Senior |
$357.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$324.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.11
|
| Rate for Payer: Heritage Provider Network Senior |
$225.11
|
| Rate for Payer: Humana Medicare |
$324.74
|
| Rate for Payer: IEHP Medi-Cal |
$513.55
|
| Rate for Payer: IEHP Medicare Advantage |
$324.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$617.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$409.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$409.18
|
| Rate for Payer: Multiplan Commercial |
$364.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$357.22
|
| Rate for Payer: TriValley Medical Group Senior |
$324.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$177.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: Vantage Medical Group Senior |
$324.74
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
OP
|
$477.59
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
1720343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.44 |
| Max. Negotiated Rate |
$789.87 |
| Rate for Payer: Adventist Health Commercial |
$95.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$789.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$328.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$405.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$357.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.68
|
| Rate for Payer: Blue Shield of California Commercial |
$386.62
|
| Rate for Payer: Blue Shield of California EPN |
$386.62
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.22
|
| Rate for Payer: Dignity Health Senior |
$357.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$324.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.12
|
| Rate for Payer: Heritage Provider Network Senior |
$221.12
|
| Rate for Payer: Humana Medicare |
$324.74
|
| Rate for Payer: IEHP Medi-Cal |
$513.55
|
| Rate for Payer: IEHP Medicare Advantage |
$324.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$617.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$409.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$409.18
|
| Rate for Payer: Multiplan Commercial |
$358.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$357.22
|
| Rate for Payer: TriValley Medical Group Senior |
$324.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.22
|
| Rate for Payer: Vantage Medical Group Senior |
$324.74
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP [22120]
|
Facility
IP
|
$477.59
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
1720343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.44 |
| Max. Negotiated Rate |
$358.19 |
| Rate for Payer: Adventist Health Commercial |
$95.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$328.10
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$323.33
|
| Rate for Payer: Heritage Provider Network Senior |
$323.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.40
|
| Rate for Payer: Multiplan Commercial |
$358.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.56
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [2851]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
1781099
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
