|
CITRULLINE 600 MG CAPSULE [13319]
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
NDC 53335-00689
|
| Hospital Charge Code |
1712162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
CITRULLINE POWDER. [40819153]
|
Facility
OP
|
$6.48
|
|
|
Service Code
|
NDC 6299127531
|
| Hospital Charge Code |
NDG19153
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$4.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.80
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.51
|
| Rate for Payer: Dignity Health Senior |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.01
|
| Rate for Payer: Heritage Provider Network Senior |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.51
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
CITRULLINE POWDER. [40819153]
|
Facility
IP
|
$6.48
|
|
|
Service Code
|
NDC 6299127531
|
| Hospital Charge Code |
NDG19153
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION [9615]
|
Facility
IP
|
$52.20
|
|
|
Service Code
|
CPT J9065
|
| Hospital Charge Code |
1755613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$39.15 |
| Rate for Payer: Adventist Health Commercial |
$10.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.86
|
| Rate for Payer: Cash Price |
$23.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.34
|
| Rate for Payer: Heritage Provider Network Senior |
$35.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$39.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.44
|
|
|
CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION [9615]
|
Facility
OP
|
$52.20
|
|
|
Service Code
|
CPT J9065
|
| Hospital Charge Code |
1755613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Adventist Health Commercial |
$10.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.40
|
| Rate for Payer: Blue Shield of California Commercial |
$35.70
|
| Rate for Payer: Blue Shield of California EPN |
$35.70
|
| Rate for Payer: Cash Price |
$23.49
|
| Rate for Payer: Cash Price |
$23.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.35
|
| Rate for Payer: Dignity Health Senior |
$17.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.17
|
| Rate for Payer: Heritage Provider Network Senior |
$24.17
|
| Rate for Payer: Humana Medicare |
$15.77
|
| Rate for Payer: IEHP Medi-Cal |
$31.56
|
| Rate for Payer: IEHP Medicare Advantage |
$15.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.87
|
| Rate for Payer: Multiplan Commercial |
$39.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.35
|
| Rate for Payer: TriValley Medical Group Senior |
$15.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15.77
|
|
|
CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]
|
Facility
OP
|
$1.41
|
|
|
Service Code
|
NDC 0781-6022-52
|
| Hospital Charge Code |
1715982
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.20
|
| Rate for Payer: Dignity Health Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.87
|
| Rate for Payer: Heritage Provider Network Senior |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
NDC 0781-6022-46
|
| Hospital Charge Code |
NDG12285
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.90
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
|
|
CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
NDC 0781-6022-46
|
| Hospital Charge Code |
NDG12285
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: Dignity Health Senior |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
CLARITHROMYCIN 125 MG/5 ML ORAL SUSPENSION [12885]
|
Facility
IP
|
$1.41
|
|
|
Service Code
|
NDC 0781-6022-52
|
| Hospital Charge Code |
1715982
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.97
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
|
|
CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]
|
Facility
IP
|
$2.06
|
|
|
Service Code
|
NDC 0781-6023-52
|
| Hospital Charge Code |
1715955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.42
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
|
|
CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]
|
Facility
OP
|
$2.06
|
|
|
Service Code
|
NDC 0781-6023-52
|
| Hospital Charge Code |
1715955
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.75
|
| Rate for Payer: Dignity Health Senior |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
CLARITHROMYCIN 250 MG TABLET [9616]
|
Facility
OP
|
$1.17
|
|
|
Service Code
|
NDC 0781-1961-60
|
| Hospital Charge Code |
1711631
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Senior |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
CLARITHROMYCIN 250 MG TABLET [9616]
|
Facility
IP
|
$1.17
|
|
|
Service Code
|
NDC 0781-1961-60
|
| Hospital Charge Code |
1711631
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Senior |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
|
|
CLARITHROMYCIN 500 MG TABLET [9617]
|
Facility
OP
|
$1.17
|
|
|
Service Code
|
NDC 0781-1962-60
|
| Hospital Charge Code |
1711531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.99
|
| Rate for Payer: Dignity Health Senior |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
|
|
CLARITHROMYCIN 500 MG TABLET [9617]
|
Facility
IP
|
$1.17
|
|
|
Service Code
|
NDC 0781-1962-60
|
| Hospital Charge Code |
1711531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.80
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Senior |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.88
|
|
|
Claviculectomy; partial
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 23120
|
| Min. Negotiated Rate |
$559.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$559.29
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
IP
|
$13,217.19
|
|
|
Service Code
|
APR-DRG 0953
|
| Min. Negotiated Rate |
$13,217.19 |
| Max. Negotiated Rate |
$13,217.19 |
| Rate for Payer: IEHP Medi-Cal |
$13,217.19
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
IP
|
$18,869.20
|
|
|
Service Code
|
APR-DRG 0954
|
| Min. Negotiated Rate |
$18,869.20 |
| Max. Negotiated Rate |
$18,869.20 |
| Rate for Payer: IEHP Medi-Cal |
$18,869.20
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
IP
|
$7,081.67
|
|
|
Service Code
|
APR-DRG 0951
|
| Min. Negotiated Rate |
$7,081.67 |
| Max. Negotiated Rate |
$7,081.67 |
| Rate for Payer: IEHP Medi-Cal |
$7,081.67
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
IP
|
$8,179.05
|
|
|
Service Code
|
APR-DRG 0952
|
| Min. Negotiated Rate |
$8,179.05 |
| Max. Negotiated Rate |
$8,179.05 |
| Rate for Payer: IEHP Medi-Cal |
$8,179.05
|
|
|
CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION [93936]
|
Facility
OP
|
$1.99
|
|
|
Service Code
|
CPT C9248
|
| Hospital Charge Code |
NDG93936
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Senior |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION [93936]
|
Facility
IP
|
$1.99
|
|
|
Service Code
|
CPT C9248
|
| Hospital Charge Code |
NDG93936
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.66
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
OP
|
$1.05
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1721155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
OP
|
$0.85
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
1720474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: Dignity Health Senior |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.90
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medi-Cal |
$9.92
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: IEHP Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [1743]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
CPT J0736
|
| Hospital Charge Code |
NDG1743A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
|
