Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
Service Code
|
ICD 0SG10KJ
|
Min. Negotiated Rate |
$13,963.00 |
Max. Negotiated Rate |
$19,930.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
Service Code
|
ICD 0SG0470
|
Min. Negotiated Rate |
$13,963.00 |
Max. Negotiated Rate |
$19,930.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
Service Code
|
ICD 0RG14J0
|
Min. Negotiated Rate |
$13,963.00 |
Max. Negotiated Rate |
$19,930.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
Service Code
|
ICD 0RG13A0
|
Min. Negotiated Rate |
$13,963.00 |
Max. Negotiated Rate |
$19,930.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
Service Code
|
ICD 0SG30AJ
|
Min. Negotiated Rate |
$13,963.00 |
Max. Negotiated Rate |
$19,930.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
Service Code
|
ICD 0SG34K0
|
Min. Negotiated Rate |
$13,963.00 |
Max. Negotiated Rate |
$19,930.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
Service Code
|
ICD 0SG50KZ
|
Min. Negotiated Rate |
$13,963.00 |
Max. Negotiated Rate |
$19,930.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
Service Code
|
ICD 00UT3JZ
|
Min. Negotiated Rate |
$17,082.00 |
Max. Negotiated Rate |
$19,930.00 |
Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
IP
|
$0.64
|
|
Service Code
|
NDC 16729-227-01
|
Hospital Charge Code |
1710137
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.48 |
Rate for Payer: Adventist Health Commercial |
$0.13
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
Rate for Payer: Cash Price |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
Rate for Payer: Heritage Provider Network Senior |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: Multiplan Commercial |
$0.48
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
OP
|
$0.47
|
|
Service Code
|
NDC 59746-218-01
|
Hospital Charge Code |
1710137
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.40 |
Rate for Payer: Adventist Health Commercial |
$0.09
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.25
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
Rate for Payer: Blue Shield of California Commercial |
$0.29
|
Rate for Payer: Blue Shield of California EPN |
$0.28
|
Rate for Payer: Cash Price |
$0.21
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.40
|
Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
Rate for Payer: Dignity Health Senior |
$0.40
|
Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
Rate for Payer: Heritage Provider Network Commercial |
$0.29
|
Rate for Payer: Heritage Provider Network Senior |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.23
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.35
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
IP
|
$0.47
|
|
Service Code
|
NDC 59746-218-01
|
Hospital Charge Code |
1710137
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.35 |
Rate for Payer: Adventist Health Commercial |
$0.09
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
Rate for Payer: Cash Price |
$0.21
|
Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
Rate for Payer: Heritage Provider Network Commercial |
$0.32
|
Rate for Payer: Heritage Provider Network Senior |
$0.32
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
Rate for Payer: Multiplan Commercial |
$0.35
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
OP
|
$0.64
|
|
Service Code
|
NDC 53746-515-01
|
Hospital Charge Code |
1710137
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.54 |
Rate for Payer: Adventist Health Commercial |
$0.13
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.34
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
Rate for Payer: Blue Shield of California Commercial |
$0.40
|
Rate for Payer: Blue Shield of California EPN |
$0.38
|
Rate for Payer: Cash Price |
$0.29
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
Rate for Payer: Dignity Health Senior |
$0.54
|
Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
Rate for Payer: Heritage Provider Network Senior |
$0.40
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: Multiplan Commercial |
$0.48
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
OP
|
$0.57
|
|
Service Code
|
NDC 53489-329-01
|
Hospital Charge Code |
1710137
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.48 |
Rate for Payer: Adventist Health Commercial |
$0.11
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.30
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
Rate for Payer: Blue Shield of California Commercial |
$0.35
|
Rate for Payer: Blue Shield of California EPN |
$0.33
|
Rate for Payer: Cash Price |
$0.26
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
Rate for Payer: Dignity Health Senior |
$0.48
|
Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
Rate for Payer: Heritage Provider Network Commercial |
$0.35
|
Rate for Payer: Heritage Provider Network Senior |
$0.35
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.27
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
Rate for Payer: Multiplan Commercial |
$0.43
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
IP
|
$0.64
|
|
Service Code
|
NDC 53746-515-01
|
Hospital Charge Code |
1710137
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.48 |
Rate for Payer: Adventist Health Commercial |
$0.13
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
Rate for Payer: Cash Price |
$0.29
|
Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
Rate for Payer: Heritage Provider Network Senior |
$0.43
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: Multiplan Commercial |
$0.48
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
OP
|
$0.64
|
|
Service Code
|
NDC 16729-227-01
|
Hospital Charge Code |
1710137
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.54 |
Rate for Payer: Adventist Health Commercial |
$0.13
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.34
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
Rate for Payer: Blue Shield of California Commercial |
$0.40
|
Rate for Payer: Blue Shield of California EPN |
$0.38
|
Rate for Payer: Cash Price |
$0.29
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
Rate for Payer: Dignity Health Senior |
$0.54
|
Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
Rate for Payer: Heritage Provider Network Senior |
$0.40
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
Rate for Payer: Multiplan Commercial |
$0.48
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
SPIRONOLACTONE 100 MG TABLET [11425]
|
Facility
IP
|
$0.57
|
|
Service Code
|
NDC 53489-329-01
|
Hospital Charge Code |
1710137
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.43 |
Rate for Payer: Adventist Health Commercial |
$0.11
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
Rate for Payer: Cash Price |
$0.26
|
Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
Rate for Payer: Heritage Provider Network Senior |
$0.39
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
Rate for Payer: Multiplan Commercial |
$0.43
|
|
SPIRONOLACTONE 12.5 MG 1/2 TABLET [4081582]
|
Facility
OP
|
$0.07
|
|
Service Code
|
NDC 9994-0815-82
|
Hospital Charge Code |
ERX4081582
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.06 |
Rate for Payer: Adventist Health Commercial |
$0.01
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
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 |
$0.05
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
Rate for Payer: Dignity Health Senior |
$0.06
|
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 |
$0.06
|
Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
SPIRONOLACTONE 12.5 MG 1/2 TABLET [4081582]
|
Facility
IP
|
$0.07
|
|
Service Code
|
NDC 9994-0815-82
|
Hospital Charge Code |
ERX4081582
|
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 |
$0.05
|
Rate for Payer: Cash Price |
$0.03
|
Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
Rate for Payer: Heritage Provider Network Senior |
$0.05
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
Rate for Payer: Multiplan Commercial |
$0.05
|
|
SPIRONOLACTONE 25 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [7439]
|
Facility
OP
|
$1.46
|
|
Service Code
|
NDC 53489-144-01
|
Hospital Charge Code |
1711768
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.26 |
Max. Negotiated Rate |
$1.24 |
Rate for Payer: Adventist Health Commercial |
$0.29
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.78
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.00
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.24
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.80
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
Rate for Payer: Blue Shield of California Commercial |
$0.91
|
Rate for Payer: Blue Shield of California EPN |
$0.86
|
Rate for Payer: Cash Price |
$0.66
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.95
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.24
|
Rate for Payer: Dignity Health Medi-Cal |
$1.24
|
Rate for Payer: Dignity Health Senior |
$1.24
|
Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
Rate for Payer: Heritage Provider Network Commercial |
$0.90
|
Rate for Payer: Heritage Provider Network Senior |
$0.90
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$0.70
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
Rate for Payer: Multiplan Commercial |
$1.10
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.24
|
Rate for Payer: Vantage Medical Group Senior |
$1.24
|
|
SPIRONOLACTONE 25 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [7439]
|
Facility
IP
|
$1.46
|
|
Service Code
|
NDC 53489-144-01
|
Hospital Charge Code |
1711768
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.26 |
Max. Negotiated Rate |
$1.10 |
Rate for Payer: Adventist Health Commercial |
$0.29
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.00
|
Rate for Payer: Cash Price |
$0.66
|
Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
Rate for Payer: Heritage Provider Network Commercial |
$0.99
|
Rate for Payer: Heritage Provider Network Senior |
$0.99
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
Rate for Payer: Multiplan Commercial |
$1.10
|
|
SPIRONOLACTONE 25 MG TABLET [7437]
|
Facility
IP
|
$0.15
|
|
Service Code
|
NDC 59651-426-01
|
Hospital Charge Code |
1710088
|
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 Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
Rate for Payer: Multiplan Commercial |
$0.11
|
|
SPIRONOLACTONE 25 MG TABLET [7437]
|
Facility
IP
|
$0.19
|
|
Service Code
|
NDC 0378-2146-01
|
Hospital Charge Code |
1710088
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
Rate for Payer: Heritage Provider Network Senior |
$0.13
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.14
|
|
SPIRONOLACTONE 25 MG TABLET [7437]
|
Facility
OP
|
$0.19
|
|
Service Code
|
NDC 0904-6927-61
|
Hospital Charge Code |
1710088
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.16 |
Rate for Payer: Adventist Health Commercial |
$0.04
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
Rate for Payer: Blue Shield of California Commercial |
$0.12
|
Rate for Payer: Blue Shield of California EPN |
$0.11
|
Rate for Payer: Cash Price |
$0.09
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
Rate for Payer: Dignity Health Senior |
$0.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
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 |
$0.09
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
Rate for Payer: Multiplan Commercial |
$0.14
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
SPIRONOLACTONE 25 MG TABLET [7437]
|
Facility
OP
|
$0.23
|
|
Service Code
|
NDC 60687-465-01
|
Hospital Charge Code |
1710088
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Adventist Health Commercial |
$0.05
|
Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.20
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.13
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
Rate for Payer: Blue Shield of California Commercial |
$0.14
|
Rate for Payer: Blue Shield of California EPN |
$0.14
|
Rate for Payer: Cash Price |
$0.10
|
Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
Rate for Payer: Dignity Health Senior |
$0.20
|
Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
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 Commercial |
$0.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
Rate for Payer: Multiplan Commercial |
$0.17
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
SPIRONOLACTONE 25 MG TABLET [7437]
|
Facility
IP
|
$0.12
|
|
Service Code
|
NDC 53489-143-01
|
Hospital Charge Code |
1710088
|
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 |
$0.08
|
Rate for Payer: Cash Price |
$0.05
|
Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
Rate for Payer: Heritage Provider Network Senior |
$0.08
|
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 |
$0.09
|
|