|
ALPRAZOLAM 0.25 MG TABLET [324]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 65862-676-01
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.03
|
| 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 0.25 MG TABLET [324]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 65862-676-01
|
| Hospital Charge Code |
901700029
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
ALPRAZOLAM 0.25 MG TABLET [324]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 60687-377-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ALPRAZOLAM 0.25 MG TABLET [324]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 60687-377-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ALPRAZOLAM 0.25 MG TABLET [324]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0228-2027-10
|
| Hospital Charge Code |
901700029
|
|
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: 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 0.25 MG TABLET [324]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0228-2027-10
|
| Hospital Charge Code |
901700029
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care 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 |
$0.03
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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
|
$0.44
|
|
|
Service Code
|
NDC 60687-388-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| 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 Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0228-2029-10
|
| Hospital Charge Code |
901700029
|
|
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: 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 0.5 MG TABLET [325]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 60687-388-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Senior |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.21
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 59762-3720-1
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.03
|
| 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
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 60687-388-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Senior |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.21
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 59762-3720-1
|
| Hospital Charge Code |
901700029
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
ALPRAZOLAM 0.5 MG TABLET [325]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0228-2029-10
|
| Hospital Charge Code |
901700029
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care 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 |
$0.03
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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
|
$0.44
|
|
|
Service Code
|
NDC 60687-388-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| 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 Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
|
|
ALPRAZOLAM 1 MG TABLET [326]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 59762-3721-1
|
| Hospital Charge Code |
901700029
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care 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 |
$0.03
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 59762-3721-1
|
| Hospital Charge Code |
901700029
|
|
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: 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
|
$0.05
|
|
|
Service Code
|
NDC 65862-678-01
|
| Hospital Charge Code |
901700029
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care 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 |
$0.02
|
| Rate for Payer: Cash Price |
$0.03
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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
|
$0.05
|
|
|
Service Code
|
NDC 65862-678-01
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.03
|
| 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 2 MG INTRA-ARTERIAL SOLUTION FOR NEURO IR [40823708]
|
Facility
|
IP
|
$183.67
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
901700025
|
|
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 |
$44.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$118.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.22
|
| 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 |
$55.55
|
| Rate for Payer: Multiplan Commercial |
$166.65
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.57
|
|
|
ALTEPLASE 2 MG INTRA-ARTERIAL SOLUTION FOR NEURO IR [40823708]
|
Facility
|
OP
|
$222.20
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$233.85 |
| Rate for Payer: Adventist Health Commercial |
$44.44
|
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$118.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$152.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89.85
|
| Rate for Payer: Blue Shield of California EPN |
$89.85
|
| Rate for Payer: Blue Shield of California EPN |
$89.85
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.57
|
| Rate for Payer: Dignity Health Senior |
$103.57
|
| Rate for Payer: Dignity Health Senior |
$103.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$94.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$94.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$87.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$105.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.63
|
| Rate for Payer: Multiplan Commercial |
$166.65
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$88.88
|
| Rate for Payer: TriValley Medical Group Senior |
$73.47
|
| Rate for Payer: TriValley Medical Group Senior |
$88.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Vantage Medical Group Senior |
$103.57
|
| Rate for Payer: Vantage Medical Group Senior |
$103.57
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [31310]
|
Facility
|
IP
|
$183.67
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
901700025
|
|
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 |
$44.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$118.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.22
|
| 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 |
$55.55
|
| Rate for Payer: Multiplan Commercial |
$166.65
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.57
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [31310]
|
Facility
|
OP
|
$222.20
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$233.85 |
| Rate for Payer: Adventist Health Commercial |
$44.44
|
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$118.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$152.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89.85
|
| Rate for Payer: Blue Shield of California EPN |
$89.85
|
| Rate for Payer: Blue Shield of California EPN |
$89.85
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.57
|
| Rate for Payer: Dignity Health Senior |
$103.57
|
| Rate for Payer: Dignity Health Senior |
$103.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$94.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$94.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$87.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$105.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.63
|
| Rate for Payer: Multiplan Commercial |
$166.65
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$88.88
|
| Rate for Payer: TriValley Medical Group Senior |
$73.47
|
| Rate for Payer: TriValley Medical Group Senior |
$88.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Vantage Medical Group Senior |
$103.57
|
| Rate for Payer: Vantage Medical Group Senior |
$103.57
|
|
|
ALTEPLASE (CATHFLO) SYRINGE 2 MG/2 ML FOR NEBULIZATION [4081953]
|
Facility
|
IP
|
$183.67
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
901700025
|
|
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 |
$44.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$118.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.22
|
| 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 |
$55.55
|
| Rate for Payer: Multiplan Commercial |
$166.65
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.57
|
|
|
ALTEPLASE (CATHFLO) SYRINGE 2 MG/2 ML FOR NEBULIZATION [4081953]
|
Facility
|
OP
|
$222.20
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$233.85 |
| Rate for Payer: Adventist Health Commercial |
$44.44
|
| Rate for Payer: Adventist Health Commercial |
$36.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$118.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$152.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89.85
|
| Rate for Payer: Blue Shield of California EPN |
$89.85
|
| Rate for Payer: Blue Shield of California EPN |
$89.85
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.57
|
| Rate for Payer: Dignity Health Senior |
$103.57
|
| Rate for Payer: Dignity Health Senior |
$103.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$94.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$94.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$87.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$105.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.63
|
| Rate for Payer: Multiplan Commercial |
$166.65
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$88.88
|
| Rate for Payer: TriValley Medical Group Senior |
$73.47
|
| Rate for Payer: TriValley Medical Group Senior |
$88.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.57
|
| Rate for Payer: Vantage Medical Group Senior |
$103.57
|
| Rate for Payer: Vantage Medical Group Senior |
$103.57
|
|
|
ALTEPLASE INTRAVENTRICULAR 2 MG/2 ML SYRINGE [40820125]
|
Facility
|
IP
|
$183.67
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
901700025
|
|
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 |
$44.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$118.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.17
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$122.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$102.88
|
| Rate for Payer: Heritage Provider Network Senior |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.22
|
| 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 |
$55.55
|
| Rate for Payer: Multiplan Commercial |
$166.65
|
| Rate for Payer: Multiplan Commercial |
$137.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.57
|
|
