|
ALENDRONATE 10 MG TABLET [15661]
|
Facility
OP
|
$0.24
|
|
|
Service Code
|
NDC 64980-340-03
|
| Hospital Charge Code |
1711759
|
|
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 |
$0.13
|
| 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 |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| 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 |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| 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 |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
ALENDRONATE 10 MG TABLET [15661]
|
Facility
IP
|
$0.24
|
|
|
Service Code
|
NDC 64980-340-03
|
| Hospital Charge Code |
1711759
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| 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 |
$0.18
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]
|
Facility
IP
|
$1.10
|
|
|
Service Code
|
NDC 0054-0282-59
|
| Hospital Charge Code |
1715162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.76
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
|
|
ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]
|
Facility
OP
|
$1.10
|
|
|
Service Code
|
NDC 0054-0282-59
|
| Hospital Charge Code |
1715162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Senior |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
OP
|
$1.65
|
|
|
Service Code
|
NDC 65862-329-04
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.40
|
| Rate for Payer: Dignity Health Senior |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1.40
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
OP
|
$0.75
|
|
|
Service Code
|
NDC 64980-342-14
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Senior |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Senior |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
IP
|
$3.35
|
|
|
Service Code
|
NDC 69543-131-20
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.30
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
IP
|
$1.65
|
|
|
Service Code
|
NDC 65862-329-04
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.13
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
IP
|
$0.75
|
|
|
Service Code
|
NDC 64980-342-14
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.52
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
|
|
ALENDRONATE 70 MG TABLET [29048]
|
Facility
OP
|
$3.35
|
|
|
Service Code
|
NDC 69543-131-20
|
| Hospital Charge Code |
1710931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.51
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.85
|
| Rate for Payer: Dignity Health Senior |
$2.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2.85
|
|
|
ALFENTANIL 500 MCG/ML INJECTION SOLUTION [25268]
|
Facility
OP
|
$4.20
|
|
|
Service Code
|
CPT J0216
|
| Hospital Charge Code |
1737010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California EPN |
$2.47
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Senior |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: IEHP Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
ALFENTANIL 500 MCG/ML INJECTION SOLUTION [25268]
|
Facility
IP
|
$4.20
|
|
|
Service Code
|
CPT J0216
|
| Hospital Charge Code |
1737010
|
|
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: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.40
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
NDC 13668-021-01
|
| Hospital Charge Code |
1710956
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| 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 |
$0.36
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
OP
|
$0.42
|
|
|
Service Code
|
NDC 47335-956-88
|
| Hospital Charge Code |
1710956
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Senior |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
NDC 13668-021-01
|
| Hospital Charge Code |
1710956
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Senior |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.30
|
| 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 |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR [36982]
|
Facility
IP
|
$0.42
|
|
|
Service Code
|
NDC 47335-956-88
|
| Hospital Charge Code |
1710956
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
|
|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION [76353]
|
Facility
IP
|
$1,123.61
|
|
|
Service Code
|
CPT J0221
|
| Hospital Charge Code |
1755758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.37 |
| Max. Negotiated Rate |
$842.71 |
| Rate for Payer: Adventist Health Commercial |
$224.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$771.92
|
| Rate for Payer: Cash Price |
$505.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$760.68
|
| Rate for Payer: Heritage Provider Network Senior |
$760.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.90
|
| Rate for Payer: Multiplan Commercial |
$842.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$409.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$375.40
|
|
|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION [76353]
|
Facility
OP
|
$1,123.61
|
|
|
Service Code
|
CPT J0221
|
| Hospital Charge Code |
1755758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.92 |
| Max. Negotiated Rate |
$842.71 |
| Rate for Payer: Adventist Health Commercial |
$224.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$484.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$771.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$246.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$217.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$217.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$299.19
|
| Rate for Payer: Blue Shield of California Commercial |
$181.92
|
| Rate for Payer: Blue Shield of California EPN |
$181.92
|
| Rate for Payer: Cash Price |
$505.62
|
| Rate for Payer: Cash Price |
$505.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.01
|
| Rate for Payer: Dignity Health Senior |
$217.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$719.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$197.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$520.23
|
| Rate for Payer: Heritage Provider Network Senior |
$520.23
|
| Rate for Payer: Humana Medicare |
$197.28
|
| Rate for Payer: IEHP Medi-Cal |
$314.71
|
| Rate for Payer: IEHP Medicare Advantage |
$197.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$374.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$232.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.57
|
| Rate for Payer: Multiplan Commercial |
$842.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.01
|
| Rate for Payer: TriValley Medical Group Senior |
$197.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$409.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$375.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.01
|
| Rate for Payer: Vantage Medical Group Senior |
$197.28
|
|
|
AL HYD-MG TR-ALG AC-SOD BICARB 80 MG-14.2 MG CHEWABLE TABLET [88365]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 0088-1175-47
|
| Hospital Charge Code |
1710445
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| 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 |
$0.06
|
|
|
AL HYD-MG TR-ALG AC-SOD BICARB 80 MG-14.2 MG CHEWABLE TABLET [88365]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 0088-1175-47
|
| Hospital Charge Code |
1710445
|
|
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
|
|
|
ALISKIREN 150 MG TABLET [78653]
|
Facility
IP
|
$11.63
|
|
|
Service Code
|
NDC 70839-150-30
|
| Hospital Charge Code |
1711903
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.99
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.87
|
| Rate for Payer: Heritage Provider Network Senior |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$8.72
|
|
|
ALISKIREN 150 MG TABLET [78653]
|
Facility
OP
|
$11.63
|
|
|
Service Code
|
NDC 70839-150-30
|
| Hospital Charge Code |
1711903
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.72
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California EPN |
$6.83
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.89
|
| Rate for Payer: Dignity Health Senior |
$9.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Senior |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$8.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.89
|
| Rate for Payer: Vantage Medical Group Senior |
$9.89
|
|
|
ALLERGIC REACTIONS
|
Facility
IP
|
$8,081.54
|
|
|
Service Code
|
APR-DRG 8113
|
| Min. Negotiated Rate |
$8,081.54 |
| Max. Negotiated Rate |
$8,081.54 |
| Rate for Payer: IEHP Medi-Cal |
$8,081.54
|
|
|
ALLERGIC REACTIONS
|
Facility
IP
|
$4,202.44
|
|
|
Service Code
|
APR-DRG 8112
|
| Min. Negotiated Rate |
$4,202.44 |
| Max. Negotiated Rate |
$4,202.44 |
| Rate for Payer: IEHP Medi-Cal |
$4,202.44
|
|
|
ALLERGIC REACTIONS
|
Facility
IP
|
$15,790.99
|
|
|
Service Code
|
APR-DRG 8114
|
| Min. Negotiated Rate |
$15,790.99 |
| Max. Negotiated Rate |
$15,790.99 |
| Rate for Payer: IEHP Medi-Cal |
$15,790.99
|
|
