|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
NDG14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.02
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
IP
|
$20.40
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
1755671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.62
|
| Rate for Payer: Heritage Provider Network Senior |
$14.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.22
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
OP
|
$20.40
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
1755671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$203.76 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.76
|
| Rate for Payer: Blue Shield of California Commercial |
$17.34
|
| Rate for Payer: Blue Shield of California Commercial |
$17.34
|
| Rate for Payer: Blue Shield of California EPN |
$17.34
|
| Rate for Payer: Blue Shield of California EPN |
$17.34
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Senior |
$18.36
|
| Rate for Payer: Dignity Health Senior |
$17.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.45
|
| Rate for Payer: Heritage Provider Network Senior |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$18.53
|
| Rate for Payer: IEHP Medi-Cal |
$18.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.34
|
| Rate for Payer: Vantage Medical Group Senior |
$17.34
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$4,565.58
|
|
|
Service Code
|
APR-DRG 7232
|
| Min. Negotiated Rate |
$4,565.58 |
| Max. Negotiated Rate |
$4,565.58 |
| Rate for Payer: IEHP Medi-Cal |
$4,565.58
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$6,851.84
|
|
|
Service Code
|
APR-DRG 7233
|
| Min. Negotiated Rate |
$6,851.84 |
| Max. Negotiated Rate |
$6,851.84 |
| Rate for Payer: IEHP Medi-Cal |
$6,851.84
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$13,534.56
|
|
|
Service Code
|
APR-DRG 7234
|
| Min. Negotiated Rate |
$13,534.56 |
| Max. Negotiated Rate |
$13,534.56 |
| Rate for Payer: IEHP Medi-Cal |
$13,534.56
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$3,200.58
|
|
|
Service Code
|
APR-DRG 7231
|
| Min. Negotiated Rate |
$3,200.58 |
| Max. Negotiated Rate |
$3,200.58 |
| Rate for Payer: IEHP Medi-Cal |
$3,200.58
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$6,286.74
|
|
|
Service Code
|
APR-DRG 0512
|
| Min. Negotiated Rate |
$6,286.74 |
| Max. Negotiated Rate |
$6,286.74 |
| Rate for Payer: IEHP Medi-Cal |
$6,286.74
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$4,174.59
|
|
|
Service Code
|
APR-DRG 0511
|
| Min. Negotiated Rate |
$4,174.59 |
| Max. Negotiated Rate |
$4,174.59 |
| Rate for Payer: IEHP Medi-Cal |
$4,174.59
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$10,449.39
|
|
|
Service Code
|
APR-DRG 0513
|
| Min. Negotiated Rate |
$10,449.39 |
| Max. Negotiated Rate |
$10,449.39 |
| Rate for Payer: IEHP Medi-Cal |
$10,449.39
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$20,778.40
|
|
|
Service Code
|
APR-DRG 0514
|
| Min. Negotiated Rate |
$20,778.40 |
| Max. Negotiated Rate |
$20,778.40 |
| Rate for Payer: IEHP Medi-Cal |
$20,778.40
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 8770140725
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| 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 |
$0.04
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 35046-001-06
|
| Hospital Charge Code |
1712644
|
|
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
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 0761-0433-10
|
| Hospital Charge Code |
1712644
|
|
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
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 35046-001-06
|
| Hospital Charge Code |
1712644
|
|
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 Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| 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
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 0761-0433-10
|
| Hospital Charge Code |
1712644
|
|
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
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 8770140725
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| 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 |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| 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 |
$0.04
|
|
|
VITAMIN A ORAL SOLUTION (IV FORM) 50,000 UNITS/ML [4080447]
|
Facility
OP
|
$20.89
|
|
|
Service Code
|
NDC 9994-0804-47
|
| Hospital Charge Code |
1715203
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Adventist Health Commercial |
$4.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.67
|
| Rate for Payer: Blue Shield of California Commercial |
$12.97
|
| Rate for Payer: Blue Shield of California EPN |
$12.26
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.76
|
| Rate for Payer: Dignity Health Senior |
$17.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.93
|
| Rate for Payer: Heritage Provider Network Senior |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$15.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.76
|
| Rate for Payer: Vantage Medical Group Senior |
$17.76
|
|
|
VITAMIN A ORAL SOLUTION (IV FORM) 50,000 UNITS/ML [4080447]
|
Facility
IP
|
$20.89
|
|
|
Service Code
|
NDC 9994-0804-47
|
| Hospital Charge Code |
1715203
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$15.67 |
| Rate for Payer: Adventist Health Commercial |
$4.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.35
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.14
|
| Rate for Payer: Heritage Provider Network Senior |
$14.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$15.67
|
|
|
VITAMIN A PALMITATE 250 MCG-VIT C 50 MG-VIT D3 10 MCG/ML ORAL DROPS [228286]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 87040303
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
VITAMIN A PALMITATE 250 MCG-VIT C 50 MG-VIT D3 10 MCG/ML ORAL DROPS [228286]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
NDC 87040303
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
VITAMIN A PALMITATE 3,000 MCG (10,000 UNIT) CAPSULE [113607]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 4098521464
|
| Hospital Charge Code |
1711121
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| 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 Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
VITAMIN A PALMITATE 3,000 MCG (10,000 UNIT) CAPSULE [113607]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 4098521464
|
| Hospital Charge Code |
1711121
|
|
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 |
$0.02
|
| 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 |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| 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 |
$0.02
|
| 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 |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
