|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$8.09
|
|
|
Service Code
|
NDC 0781-1943-39
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4.93
|
| Rate for Payer: Blue Shield of California EPN |
$3.95
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.88
|
| Rate for Payer: Dignity Health Senior |
$6.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.01
|
| Rate for Payer: Heritage Provider Network Senior |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.66
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.88
|
| Rate for Payer: Vantage Medical Group Senior |
$6.88
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
IP
|
$8.09
|
|
|
Service Code
|
NDC 0781-1943-82
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.07 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.48
|
| Rate for Payer: Heritage Provider Network Senior |
$5.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$8.09
|
|
|
Service Code
|
NDC 0781-1943-82
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4.93
|
| Rate for Payer: Blue Shield of California EPN |
$3.95
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.88
|
| Rate for Payer: Dignity Health Senior |
$6.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.01
|
| Rate for Payer: Heritage Provider Network Senior |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.66
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.88
|
| Rate for Payer: Vantage Medical Group Senior |
$6.88
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
IP
|
$8.04
|
|
|
Service Code
|
NDC 43598-020-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$8.04
|
|
|
Service Code
|
NDC 43598-020-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: Dignity Health Senior |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.22
|
| Rate for Payer: TriValley Medical Group Senior |
$3.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 43598-220-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.54
|
| Rate for Payer: Heritage Provider Network Senior |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.03
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 43598-220-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4.09
|
| Rate for Payer: Blue Shield of California EPN |
$3.27
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$5.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.70
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
|
IP
|
$57.60
|
|
|
Service Code
|
HCPCS J0285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Adventist Health Commercial |
$11.52
|
| Rate for Payer: Cash Price |
$31.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.67
|
| Rate for Payer: Heritage Provider Network Senior |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.07
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
|
OP
|
$57.60
|
|
|
Service Code
|
HCPCS J0285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Adventist Health Commercial |
$11.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.50
|
| Rate for Payer: Blue Shield of California Commercial |
$51.00
|
| Rate for Payer: Blue Shield of California EPN |
$51.00
|
| Rate for Payer: Cash Price |
$31.68
|
| Rate for Payer: Cash Price |
$31.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.96
|
| Rate for Payer: Dignity Health Senior |
$48.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.67
|
| Rate for Payer: Heritage Provider Network Senior |
$26.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.04
|
| Rate for Payer: TriValley Medical Group Senior |
$23.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.96
|
| Rate for Payer: Vantage Medical Group Senior |
$48.96
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
|
OP
|
$381.97
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$286.48 |
| Rate for Payer: Adventist Health Commercial |
$76.39
|
| Rate for Payer: Adventist Health Commercial |
$57.29
|
| Rate for Payer: Adventist Health Commercial |
$61.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$204.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$153.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$163.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$262.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.96
|
| Rate for Payer: Blue Shield of California Commercial |
$51.97
|
| Rate for Payer: Blue Shield of California Commercial |
$51.97
|
| Rate for Payer: Blue Shield of California Commercial |
$51.97
|
| Rate for Payer: Blue Shield of California EPN |
$51.97
|
| Rate for Payer: Blue Shield of California EPN |
$51.97
|
| Rate for Payer: Blue Shield of California EPN |
$51.97
|
| Rate for Payer: Cash Price |
$168.14
|
| Rate for Payer: Cash Price |
$168.14
|
| Rate for Payer: Cash Price |
$157.54
|
| Rate for Payer: Cash Price |
$210.08
|
| Rate for Payer: Cash Price |
$157.54
|
| Rate for Payer: Cash Price |
$210.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$140.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.88
|
| Rate for Payer: Dignity Health Senior |
$24.88
|
| Rate for Payer: Dignity Health Senior |
$24.88
|
| Rate for Payer: Dignity Health Senior |
$24.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.62
|
| Rate for Payer: Heritage Provider Network Senior |
$141.54
|
| Rate for Payer: Heritage Provider Network Senior |
$176.85
|
| Rate for Payer: Heritage Provider Network Senior |
$132.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$182.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$136.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$229.28
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: Multiplan Commercial |
$286.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$114.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$152.79
|
| Rate for Payer: TriValley Medical Group Senior |
$114.58
|
| Rate for Payer: TriValley Medical Group Senior |
$122.28
|
| Rate for Payer: TriValley Medical Group Senior |
$152.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$110.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$138.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$101.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$126.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Vantage Medical Group Senior |
$24.88
|
| Rate for Payer: Vantage Medical Group Senior |
$24.88
|
| Rate for Payer: Vantage Medical Group Senior |
$24.88
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
|
IP
|
$305.70
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$229.28 |
| Rate for Payer: Adventist Health Commercial |
$61.14
|
| Rate for Payer: Adventist Health Commercial |
$57.29
|
| Rate for Payer: Adventist Health Commercial |
$76.39
|
| Rate for Payer: Cash Price |
$168.14
|
| Rate for Payer: Cash Price |
$210.08
|
| Rate for Payer: Cash Price |
$157.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$140.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.54
|
| Rate for Payer: Heritage Provider Network Senior |
$141.54
|
| Rate for Payer: Heritage Provider Network Senior |
$132.62
|
| Rate for Payer: Heritage Provider Network Senior |
$176.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.49
|
| Rate for Payer: Multiplan Commercial |
$286.48
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: Multiplan Commercial |
$229.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$138.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$110.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$126.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$101.22
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
|
IP
|
$4.56
|
|
|
Service Code
|
NDC 9994-0802-41
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
|
OP
|
$4.56
|
|
|
Service Code
|
NDC 9994-0802-41
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.88
|
| Rate for Payer: Dignity Health Senior |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Senior |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3.88
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
|
IP
|
$82.77
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$45.52
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.32
|
| Rate for Payer: Heritage Provider Network Senior |
$38.32
|
| Rate for Payer: Heritage Provider Network Senior |
$36.11
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.41
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$70.35 |
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$45.52
|
| Rate for Payer: Cash Price |
$45.52
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Senior |
$76.50
|
| Rate for Payer: Dignity Health Senior |
$66.30
|
| Rate for Payer: Dignity Health Senior |
$70.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.32
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$36.11
|
| Rate for Payer: Heritage Provider Network Senior |
$38.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.08
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Senior |
$31.20
|
| Rate for Payer: TriValley Medical Group Senior |
$36.00
|
| Rate for Payer: TriValley Medical Group Senior |
$33.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$70.35
|
|
|
AMPICILLIN 1G/50ML NS IV ADMIXTURE KIT (ADSOK) [200002]
|
Facility
|
IP
|
$7.08
|
|
|
Service Code
|
NDC 9999-2000-02
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$1.42
|
| Rate for Payer: Cash Price |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.31
|
|
|
AMPICILLIN 1G/50ML NS IV ADMIXTURE KIT (ADSOK) [200002]
|
Facility
|
OP
|
$7.08
|
|
|
Service Code
|
NDC 9999-2000-02
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Adventist Health Commercial |
$1.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.31
|
| Rate for Payer: Blue Shield of California Commercial |
$4.32
|
| Rate for Payer: Blue Shield of California EPN |
$3.46
|
| Rate for Payer: Cash Price |
$3.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.02
|
| Rate for Payer: Dignity Health Senior |
$6.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.38
|
| Rate for Payer: Heritage Provider Network Senior |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$5.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.02
|
| Rate for Payer: Vantage Medical Group Senior |
$6.02
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
|
IP
|
$6.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.20
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
|
OP
|
$6.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$4.94
|
| Rate for Payer: Dignity Health Senior |
$5.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.32
|
| Rate for Payer: TriValley Medical Group Senior |
$2.32
|
| Rate for Payer: TriValley Medical Group Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Senior |
$2.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$4.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.64
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: Dignity Health Senior |
$7.25
|
| Rate for Payer: Dignity Health Senior |
$13.67
|
| Rate for Payer: Dignity Health Senior |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3.95
|
| Rate for Payer: Heritage Provider Network Senior |
$7.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.26
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.43
|
| Rate for Payer: TriValley Medical Group Senior |
$6.43
|
| Rate for Payer: TriValley Medical Group Senior |
$3.41
|
| Rate for Payer: TriValley Medical Group Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$13.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.39
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Senior |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.12
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: Dignity Health Senior |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Senior |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
|
