|
SITAGLIPTIN PHOSPHATE 100 MG TABLET [77617]
|
Facility
OP
|
$21.89
|
|
|
Service Code
|
NDC 0006-0277-31
|
| Hospital Charge Code |
1711892
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.42
|
| Rate for Payer: Blue Shield of California Commercial |
$13.59
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.61
|
| Rate for Payer: Dignity Health Senior |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.55
|
| Rate for Payer: Heritage Provider Network Senior |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
SITAGLIPTIN PHOSPHATE 100 MG TABLET [77617]
|
Facility
IP
|
$21.89
|
|
|
Service Code
|
NDC 0006-0277-31
|
| Hospital Charge Code |
1711892
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.42 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.04
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.82
|
| Rate for Payer: Heritage Provider Network Senior |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
|
|
SITAGLIPTIN PHOSPHATE 25 MG TABLET [77615]
|
Facility
IP
|
$21.89
|
|
|
Service Code
|
NDC 0006-0221-31
|
| Hospital Charge Code |
1711890
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.42 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.04
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.82
|
| Rate for Payer: Heritage Provider Network Senior |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
|
|
SITAGLIPTIN PHOSPHATE 25 MG TABLET [77615]
|
Facility
OP
|
$21.89
|
|
|
Service Code
|
NDC 0006-0221-31
|
| Hospital Charge Code |
1711890
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.42
|
| Rate for Payer: Blue Shield of California Commercial |
$13.59
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.61
|
| Rate for Payer: Dignity Health Senior |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.55
|
| Rate for Payer: Heritage Provider Network Senior |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
SITAGLIPTIN PHOSPHATE 50 MG TABLET [77616]
|
Facility
IP
|
$21.89
|
|
|
Service Code
|
NDC 0006-0112-28
|
| Hospital Charge Code |
1711891
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.42 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.04
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.82
|
| Rate for Payer: Heritage Provider Network Senior |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
|
|
SITAGLIPTIN PHOSPHATE 50 MG TABLET [77616]
|
Facility
OP
|
$21.89
|
|
|
Service Code
|
NDC 0006-0112-31
|
| Hospital Charge Code |
1711891
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.42
|
| Rate for Payer: Blue Shield of California Commercial |
$13.59
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.61
|
| Rate for Payer: Dignity Health Senior |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.55
|
| Rate for Payer: Heritage Provider Network Senior |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
SITAGLIPTIN PHOSPHATE 50 MG TABLET [77616]
|
Facility
IP
|
$21.89
|
|
|
Service Code
|
NDC 0006-0112-31
|
| Hospital Charge Code |
1711891
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.42 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.04
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.82
|
| Rate for Payer: Heritage Provider Network Senior |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
|
|
SITAGLIPTIN PHOSPHATE 50 MG TABLET [77616]
|
Facility
OP
|
$21.89
|
|
|
Service Code
|
NDC 0006-0112-28
|
| Hospital Charge Code |
1711891
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.42
|
| Rate for Payer: Blue Shield of California Commercial |
$13.59
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.61
|
| Rate for Payer: Dignity Health Senior |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.55
|
| Rate for Payer: Heritage Provider Network Senior |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
IP
|
$15,957.14
|
|
|
Service Code
|
APR-DRG 3122
|
| Min. Negotiated Rate |
$15,957.14 |
| Max. Negotiated Rate |
$15,957.14 |
| Rate for Payer: IEHP Medi-Cal |
$15,957.14
|
|
|
SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
IP
|
$26,953.72
|
|
|
Service Code
|
APR-DRG 3123
|
| Min. Negotiated Rate |
$26,953.72 |
| Max. Negotiated Rate |
$26,953.72 |
| Rate for Payer: IEHP Medi-Cal |
$26,953.72
|
|
|
SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
IP
|
$9,960.89
|
|
|
Service Code
|
APR-DRG 3121
|
| Min. Negotiated Rate |
$9,960.89 |
| Max. Negotiated Rate |
$9,960.89 |
| Rate for Payer: IEHP Medi-Cal |
$9,960.89
|
|
|
SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
IP
|
$54,663.56
|
|
|
Service Code
|
APR-DRG 3124
|
| Min. Negotiated Rate |
$54,663.56 |
| Max. Negotiated Rate |
$54,663.56 |
| Rate for Payer: IEHP Medi-Cal |
$54,663.56
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
IP
|
$23,022.89
|
|
|
Service Code
|
APR-DRG 3613
|
| Min. Negotiated Rate |
$23,022.89 |
| Max. Negotiated Rate |
$23,022.89 |
| Rate for Payer: IEHP Medi-Cal |
$23,022.89
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
IP
|
$46,292.52
|
|
|
Service Code
|
APR-DRG 3614
|
| Min. Negotiated Rate |
$46,292.52 |
| Max. Negotiated Rate |
$46,292.52 |
| Rate for Payer: IEHP Medi-Cal |
$46,292.52
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
IP
|
$12,155.64
|
|
|
Service Code
|
APR-DRG 3611
|
| Min. Negotiated Rate |
$12,155.64 |
| Max. Negotiated Rate |
$12,155.64 |
| Rate for Payer: IEHP Medi-Cal |
$12,155.64
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
IP
|
$15,098.54
|
|
|
Service Code
|
APR-DRG 3612
|
| Min. Negotiated Rate |
$15,098.54 |
| Max. Negotiated Rate |
$15,098.54 |
| Rate for Payer: IEHP Medi-Cal |
$15,098.54
|
|
|
SKIN ULCERS
|
Facility
IP
|
$4,638.20
|
|
|
Service Code
|
APR-DRG 3801
|
| Min. Negotiated Rate |
$4,638.20 |
| Max. Negotiated Rate |
$4,638.20 |
| Rate for Payer: IEHP Medi-Cal |
$4,638.20
|
|
|
SKIN ULCERS
|
Facility
IP
|
$15,313.44
|
|
|
Service Code
|
APR-DRG 3804
|
| Min. Negotiated Rate |
$15,313.44 |
| Max. Negotiated Rate |
$15,313.44 |
| Rate for Payer: IEHP Medi-Cal |
$15,313.44
|
|
|
SKIN ULCERS
|
Facility
IP
|
$6,039.01
|
|
|
Service Code
|
APR-DRG 3802
|
| Min. Negotiated Rate |
$6,039.01 |
| Max. Negotiated Rate |
$6,039.01 |
| Rate for Payer: IEHP Medi-Cal |
$6,039.01
|
|
|
SKIN ULCERS
|
Facility
IP
|
$8,737.18
|
|
|
Service Code
|
APR-DRG 3803
|
| Min. Negotiated Rate |
$8,737.18 |
| Max. Negotiated Rate |
$8,737.18 |
| Rate for Payer: IEHP Medi-Cal |
$8,737.18
|
|
|
Sling operation for stress incontinence (eg, fascia or synthetic)
|
Facility
OP
|
$11,807.68
|
|
|
Service Code
|
CPT 57288
|
| Min. Negotiated Rate |
$1,209.39 |
| Max. Negotiated Rate |
$11,807.68 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,836.03
|
| Rate for Payer: Dignity Health Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,214.57
|
| Rate for Payer: Humana Medicare |
$6,214.57
|
| Rate for Payer: IEHP Medi-Cal |
$1,209.39
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,807.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,333.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,830.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,830.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,836.03
|
| Rate for Payer: TriValley Medical Group Senior |
$6,214.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 44376
|
| Min. Negotiated Rate |
$393.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: IEHP Medi-Cal |
$393.78
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,615.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,377.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
SODIUM ACETATE 4 MEQ/ML INTRAVENOUS SOLUTION [7302]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 63323-032-04
|
| Hospital Charge Code |
NDG7302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.05
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
SODIUM ACETATE 4 MEQ/ML INTRAVENOUS SOLUTION [7302]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 63323-032-04
|
| Hospital Charge Code |
NDG7302
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
SODIUM ACETATE 4 MEQ/ML INTRAVENOUS SOLUTION [7302]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 63323-032-00
|
| Hospital Charge Code |
NDG7302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.05
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
