|
ZIPRASIDONE 80 MG CAPSULE [29781]
|
Facility
IP
|
$3.32
|
|
|
Service Code
|
NDC 68084-106-11
|
| Hospital Charge Code |
1712252
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.28
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
|
|
ZIPRASIDONE 80 MG CAPSULE [29781]
|
Facility
OP
|
$1.80
|
|
|
Service Code
|
NDC 60505-2531-6
|
| Hospital Charge Code |
1712252
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Senior |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
ZIPRASIDONE 80 MG CAPSULE [29781]
|
Facility
IP
|
$3.32
|
|
|
Service Code
|
NDC 68084-106-09
|
| Hospital Charge Code |
1712252
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.28
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
|
|
ZIPRASIDONE 80 MG CAPSULE [29781]
|
Facility
OP
|
$3.32
|
|
|
Service Code
|
NDC 68084-106-09
|
| Hospital Charge Code |
1712252
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.82
|
| Rate for Payer: Dignity Health Senior |
$2.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Vantage Medical Group Senior |
$2.82
|
|
|
ZIPRASIDONE 80 MG CAPSULE [29781]
|
Facility
IP
|
$1.80
|
|
|
Service Code
|
NDC 60505-2531-6
|
| Hospital Charge Code |
1712252
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
|
|
ZIV-AFLIBERCEPT 100 MG/4 ML (25 MG/ML) INTRAVENOUS SOLUTION [197072]
|
Facility
IP
|
$480.00
|
|
|
Service Code
|
NDC 0024-5840-01
|
| Hospital Charge Code |
NDG197072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$220.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$175.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$160.37
|
|
|
ZIV-AFLIBERCEPT 100 MG/4 ML (25 MG/ML) INTRAVENOUS SOLUTION [197072]
|
Facility
OP
|
$480.00
|
|
|
Service Code
|
NDC 0024-5840-01
|
| Hospital Charge Code |
NDG197072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$256.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$264.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$360.00
|
| Rate for Payer: Blue Shield of California Commercial |
$298.08
|
| Rate for Payer: Blue Shield of California EPN |
$281.76
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$220.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.00
|
| Rate for Payer: Dignity Health Senior |
$408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.24
|
| Rate for Payer: Heritage Provider Network Senior |
$222.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$231.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$175.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$160.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.00
|
| Rate for Payer: Vantage Medical Group Senior |
$408.00
|
|
|
ZIV-AFLIBERCEPT 200 MG/8 ML (25 MG/ML) INTRAVENOUS SOLUTION [197073]
|
Facility
OP
|
$480.00
|
|
|
Service Code
|
CPT J9400
|
| Hospital Charge Code |
NDG197073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.21
|
| Rate for Payer: Blue Shield of California Commercial |
$16.32
|
| Rate for Payer: Blue Shield of California EPN |
$16.32
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$220.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.01
|
| Rate for Payer: Dignity Health Senior |
$8.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.24
|
| Rate for Payer: Heritage Provider Network Senior |
$222.24
|
| Rate for Payer: Humana Medicare |
$7.28
|
| Rate for Payer: IEHP Medi-Cal |
$18.31
|
| Rate for Payer: IEHP Medicare Advantage |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.01
|
| Rate for Payer: TriValley Medical Group Senior |
$7.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$175.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$160.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.28
|
|
|
ZIV-AFLIBERCEPT 200 MG/8 ML (25 MG/ML) INTRAVENOUS SOLUTION [197073]
|
Facility
IP
|
$480.00
|
|
|
Service Code
|
CPT J9400
|
| Hospital Charge Code |
NDG197073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$220.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$175.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$160.37
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [201638]
|
Facility
OP
|
$2.16
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
NDG201638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$365.54 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Senior |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK [201638]
|
Facility
IP
|
$2.16
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
NDG201638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.48
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.72
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
1722044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$365.54 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Senior |
$9.02
|
| Rate for Payer: Dignity Health Senior |
$36.72
|
| Rate for Payer: Dignity Health Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.91
|
| Rate for Payer: Heritage Provider Network Senior |
$20.00
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.72
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
| Rate for Payer: Vantage Medical Group Senior |
$36.72
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION [35640]
|
Facility
IP
|
$10.61
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
1722044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$29.25
|
| Rate for Payer: Heritage Provider Network Senior |
$7.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.43
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
1753467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$365.54 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.54
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California Commercial |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.66
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.15
|
| Rate for Payer: Dignity Health Senior |
$2.40
|
| Rate for Payer: Dignity Health Senior |
$3.57
|
| Rate for Payer: Dignity Health Senior |
$2.30
|
| Rate for Payer: Dignity Health Senior |
$12.15
|
| Rate for Payer: Dignity Health Senior |
$3.06
|
| Rate for Payer: Dignity Health Senior |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1.25
|
| Rate for Payer: Heritage Provider Network Senior |
$6.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: IEHP Medi-Cal |
$18.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Multiplan Commercial |
$10.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$12.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK [81434]
|
Facility
IP
|
$4.20
|
|
|
Service Code
|
CPT J3489
|
| Hospital Charge Code |
1753467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.82
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.91
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$10.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.91
|
|
|
ZOLMITRIPTAN 2.5 MG NASAL SPRAY [204298]
|
Facility
OP
|
$117.31
|
|
|
Service Code
|
NDC 64896-682-51
|
| Hospital Charge Code |
ERX204298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$99.71 |
| Rate for Payer: Adventist Health Commercial |
$23.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$99.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$87.98
|
| Rate for Payer: Blue Shield of California Commercial |
$72.85
|
| Rate for Payer: Blue Shield of California EPN |
$68.86
|
| Rate for Payer: Cash Price |
$52.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.71
|
| Rate for Payer: Dignity Health Senior |
$99.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.61
|
| Rate for Payer: Heritage Provider Network Senior |
$72.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.33
|
| Rate for Payer: Multiplan Commercial |
$87.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.71
|
| Rate for Payer: Vantage Medical Group Senior |
$99.71
|
|
|
ZOLMITRIPTAN 2.5 MG NASAL SPRAY [204298]
|
Facility
IP
|
$117.31
|
|
|
Service Code
|
NDC 64896-682-51
|
| Hospital Charge Code |
ERX204298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$87.98 |
| Rate for Payer: Adventist Health Commercial |
$23.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.59
|
| Rate for Payer: Cash Price |
$52.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.42
|
| Rate for Payer: Heritage Provider Network Senior |
$79.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.33
|
| Rate for Payer: Multiplan Commercial |
$87.98
|
|
|
ZOLPIDEM 10 MG TABLET [11700]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 65862-160-01
|
| Hospital Charge Code |
1731007
|
|
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
|
|
|
ZOLPIDEM 10 MG TABLET [11700]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 65862-160-01
|
| Hospital Charge Code |
1731007
|
|
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
|
|
|
ZOLPIDEM 10 MG TABLET [11700]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 13668-008-01
|
| Hospital Charge Code |
1731007
|
|
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
|
|
|
ZOLPIDEM 10 MG TABLET [11700]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 13668-008-01
|
| Hospital Charge Code |
1731007
|
|
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 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
|
|
|
ZOLPIDEM 5 MG TABLET [11701]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
NDC 0904-6082-61
|
| Hospital Charge Code |
1731008
|
|
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 |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| 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
|
|
|
ZOLPIDEM 5 MG TABLET [11701]
|
Facility
IP
|
$0.13
|
|
|
Service Code
|
NDC 51079-724-20
|
| Hospital Charge Code |
1731008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| 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 |
$0.10
|
|
|
ZOLPIDEM 5 MG TABLET [11701]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 0781-5317-01
|
| Hospital Charge Code |
1731008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| 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 |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| 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 Commercial |
$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 |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
ZOLPIDEM 5 MG TABLET [11701]
|
Facility
OP
|
$0.13
|
|
|
Service Code
|
NDC 51079-724-20
|
| Hospital Charge Code |
1731008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| 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 Commercial |
$0.06
|
| 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 |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
