|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 0228-2029-10
|
| Hospital Charge Code |
1730012
|
|
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
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 65862-677-01
|
| Hospital Charge Code |
1730012
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 0228-2029-10
|
| Hospital Charge Code |
1730012
|
|
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
|
|
|
ALPRAZOLAM 1 MG TABLET [326]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 59762-3721-1
|
| Hospital Charge Code |
1730117
|
|
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
|
|
|
ALPRAZOLAM 1 MG TABLET [326]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 65862-678-01
|
| Hospital Charge Code |
1730117
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: Dignity Health Senior |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
ALPRAZOLAM 1 MG TABLET [326]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 59762-3721-1
|
| Hospital Charge Code |
1730117
|
|
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
|
|
|
ALPRAZOLAM 1 MG TABLET [326]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 65862-678-01
|
| Hospital Charge Code |
1730117
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION [9002]
|
Facility
IP
|
$10,560.43
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
1720787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,911.44 |
| Max. Negotiated Rate |
$7,920.32 |
| Rate for Payer: Adventist Health Commercial |
$2,112.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,644.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,255.02
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,857.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,702.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,149.41
|
| Rate for Payer: Heritage Provider Network Senior |
$7,149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.11
|
| Rate for Payer: Multiplan Commercial |
$7,920.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,850.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,528.24
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION [9002]
|
Facility
OP
|
$10,560.43
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
1720787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.90 |
| Max. Negotiated Rate |
$7,920.32 |
| Rate for Payer: Adventist Health Commercial |
$2,112.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,644.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,255.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,857.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,758.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,889.48
|
| Rate for Payer: Heritage Provider Network Senior |
$4,889.48
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Multiplan Commercial |
$7,920.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,850.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,528.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION (ACUTE THROMBOEMBOLIC STROKE) [4081495]
|
Facility
IP
|
$10,560.43
|
|
|
Service Code
|
CPT J2997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,911.44 |
| Max. Negotiated Rate |
$7,920.32 |
| Rate for Payer: Adventist Health Commercial |
$2,112.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,644.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,255.02
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,857.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,702.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,149.41
|
| Rate for Payer: Heritage Provider Network Senior |
$7,149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.11
|
| Rate for Payer: Multiplan Commercial |
$7,920.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,850.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,528.24
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION (ACUTE THROMBOEMBOLIC STROKE) [4081495]
|
Facility
OP
|
$10,560.43
|
|
|
Service Code
|
CPT J2997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.90 |
| Max. Negotiated Rate |
$7,920.32 |
| Rate for Payer: Adventist Health Commercial |
$2,112.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,644.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,255.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cash Price |
$4,752.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,857.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,758.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,889.48
|
| Rate for Payer: Heritage Provider Network Senior |
$4,889.48
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Multiplan Commercial |
$7,920.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,850.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,528.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE 2 MG INTRA-ARTERIAL SOLUTION FOR NEURO IR [40823708]
|
Facility
OP
|
$201.54
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX40823708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$169.05 |
| Rate for Payer: Adventist Health Commercial |
$40.31
|
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.31
|
| Rate for Payer: Heritage Provider Network Senior |
$93.31
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: Multiplan Commercial |
$151.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE 2 MG INTRA-ARTERIAL SOLUTION FOR NEURO IR [40823708]
|
Facility
IP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX40823708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Adventist Health Commercial |
$40.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.34
|
| Rate for Payer: Heritage Provider Network Senior |
$124.34
|
| Rate for Payer: Heritage Provider Network Senior |
$136.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Multiplan Commercial |
$151.16
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.36
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [31310]
|
Facility
OP
|
$201.54
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
1720932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$169.05 |
| Rate for Payer: Adventist Health Commercial |
$40.31
|
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Heritage Provider Network Senior |
$93.31
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Multiplan Commercial |
$151.16
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [31310]
|
Facility
IP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
1720932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Adventist Health Commercial |
$40.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.34
|
| Rate for Payer: Heritage Provider Network Senior |
$124.34
|
| Rate for Payer: Heritage Provider Network Senior |
$136.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.38
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: Multiplan Commercial |
$151.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.33
|
|
|
ALTEPLASE (CATHFLO) SYRINGE 2 MG/2 ML FOR NEBULIZATION [4081953]
|
Facility
IP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX4081953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Adventist Health Commercial |
$40.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.34
|
| Rate for Payer: Heritage Provider Network Senior |
$124.34
|
| Rate for Payer: Heritage Provider Network Senior |
$136.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: Multiplan Commercial |
$151.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.36
|
|
|
ALTEPLASE (CATHFLO) SYRINGE 2 MG/2 ML FOR NEBULIZATION [4081953]
|
Facility
OP
|
$201.54
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX4081953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$169.05 |
| Rate for Payer: Adventist Health Commercial |
$40.31
|
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.31
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Heritage Provider Network Senior |
$93.31
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Multiplan Commercial |
$151.16
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTEPLASE INTRAVENTRICULAR 2 MG/2 ML SYRINGE [40820125]
|
Facility
IP
|
$201.54
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX40820125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$151.16 |
| Rate for Payer: Adventist Health Commercial |
$40.31
|
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.44
|
| Rate for Payer: Heritage Provider Network Senior |
$124.34
|
| Rate for Payer: Heritage Provider Network Senior |
$136.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.38
|
| Rate for Payer: Multiplan Commercial |
$151.16
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.33
|
|
|
ALTEPLASE INTRAVENTRICULAR 2 MG/2 ML SYRINGE [40820125]
|
Facility
OP
|
$183.67
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
ERX40820125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$169.05 |
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Adventist Health Commercial |
$40.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.90
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$81.97
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cash Price |
$90.69
|
| Rate for Payer: Cash Price |
$82.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: Dignity Health Senior |
$97.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Heritage Provider Network Senior |
$93.31
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medi-Cal |
$145.75
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: IEHP Medicare Advantage |
$88.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.11
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: Multiplan Commercial |
$151.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$97.87
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: TriValley Medical Group Senior |
$88.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
| Rate for Payer: Vantage Medical Group Senior |
$88.97
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
IP
|
$15,205.99
|
|
|
Service Code
|
APR-DRG 0524
|
| Min. Negotiated Rate |
$15,205.99 |
| Max. Negotiated Rate |
$15,205.99 |
| Rate for Payer: IEHP Medi-Cal |
$15,205.99
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
IP
|
$5,053.07
|
|
|
Service Code
|
APR-DRG 0521
|
| Min. Negotiated Rate |
$5,053.07 |
| Max. Negotiated Rate |
$5,053.07 |
| Rate for Payer: IEHP Medi-Cal |
$5,053.07
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
IP
|
$5,981.31
|
|
|
Service Code
|
APR-DRG 0522
|
| Min. Negotiated Rate |
$5,981.31 |
| Max. Negotiated Rate |
$5,981.31 |
| Rate for Payer: IEHP Medi-Cal |
$5,981.31
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
IP
|
$7,775.11
|
|
|
Service Code
|
APR-DRG 0523
|
| Min. Negotiated Rate |
$7,775.11 |
| Max. Negotiated Rate |
$7,775.11 |
| Rate for Payer: IEHP Medi-Cal |
$7,775.11
|
|
|
ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION [353]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
NDC 0536-0091-85
|
| Hospital Charge Code |
NDG353B
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION [353]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 0536-0091-85
|
| Hospital Charge Code |
NDG353B
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Senior |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
