|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 0487990425
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 0487990401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Senior |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [31578]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 0487990401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0487950101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [250]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0487950101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
ALBUTEROL SULFATE 2 MG TABLET [253]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 6923813441
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
ALBUTEROL SULFATE 2 MG TABLET [253]
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
NDC 6808494995
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.65
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.23
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
ALBUTEROL SULFATE 2 MG TABLET [253]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 6923813441
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.46
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
|
|
ALBUTEROL SULFATE 2 MG TABLET [253]
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
NDC 6808494995
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
|
ALBUTEROL SULFATE 2 MG TABLET [253]
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
NDC 6808494925
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.65
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.23
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
ALBUTEROL SULFATE 2 MG TABLET [253]
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
NDC 6808494925
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081891]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 0487990130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.78
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLN FOR NEBULIZATION FOR STATUS ASTHMATICUS [4081891]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 0487990130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION [116907]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 0487990130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION [116907]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 0487990130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.78
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 7317714633
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION [251]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 7317714633
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.93
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
|
IP
|
$10,174.39
|
|
|
Service Code
|
MSDRG 894
|
| Min. Negotiated Rate |
$7,592.83 |
| Max. Negotiated Rate |
$10,174.39 |
| Rate for Payer: EPIC Health Plan Medicare |
$7,592.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,592.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,731.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,174.39
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
|
IP
|
$27,498.43
|
|
|
Service Code
|
MSDRG 896
|
| Min. Negotiated Rate |
$20,521.22 |
| Max. Negotiated Rate |
$27,498.43 |
| Rate for Payer: EPIC Health Plan Medicare |
$20,521.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,521.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,599.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,498.43
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
|
IP
|
$14,257.40
|
|
|
Service Code
|
MSDRG 897
|
| Min. Negotiated Rate |
$10,639.85 |
| Max. Negotiated Rate |
$14,257.40 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,639.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,639.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,235.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,257.40
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
|
IP
|
$22,438.80
|
|
|
Service Code
|
MSDRG 895
|
| Min. Negotiated Rate |
$16,745.37 |
| Max. Negotiated Rate |
$22,438.80 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,745.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,745.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,257.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,438.80
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
|
IP
|
$102.20
|
|
|
Service Code
|
NDC 5024213001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$76.65 |
| Rate for Payer: Adventist Health Commercial |
$20.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.82
|
| Rate for Payer: Cash Price |
$45.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.19
|
| Rate for Payer: Heritage Provider Network Senior |
$69.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.55
|
| Rate for Payer: Multiplan Commercial |
$76.65
|
|
|
ALECTINIB 150 MG CAPSULE [212384]
|
Facility
|
OP
|
$102.20
|
|
|
Service Code
|
NDC 5024213001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$86.87 |
| Rate for Payer: Adventist Health Commercial |
$20.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.12
|
| Rate for Payer: Blue Shield of California Commercial |
$62.34
|
| Rate for Payer: Blue Shield of California EPN |
$49.87
|
| Rate for Payer: Cash Price |
$45.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.26
|
| Rate for Payer: Heritage Provider Network Senior |
$63.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$48.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.54
|
| Rate for Payer: Multiplan Commercial |
$76.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.88
|
| Rate for Payer: TriValley Medical Group Senior |
$40.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.87
|
| Rate for Payer: Vantage Medical Group Senior |
$86.87
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
|
IP
|
$30,041.68
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,437.54 |
| Max. Negotiated Rate |
$22,531.26 |
| Rate for Payer: Adventist Health Commercial |
$6,008.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,346.84
|
| Rate for Payer: Cash Price |
$13,518.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,819.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,222.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,909.30
|
| Rate for Payer: Heritage Provider Network Senior |
$13,909.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,437.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,510.42
|
| Rate for Payer: Multiplan Commercial |
$22,531.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,854.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,946.80
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]
|
Facility
|
OP
|
$30,041.68
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,478.45 |
| Max. Negotiated Rate |
$22,531.26 |
| Rate for Payer: Adventist Health Commercial |
$6,008.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,565.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,181.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,799.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,989.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,478.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,478.45
|
| Rate for Payer: Cash Price |
$13,518.76
|
| Rate for Payer: Cash Price |
$13,518.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,819.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,181.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,799.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,226.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,909.30
|
| Rate for Payer: Heritage Provider Network Senior |
$13,909.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,329.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,437.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,926.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,510.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,410.22
|
| Rate for Payer: Multiplan Commercial |
$22,531.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$12,016.67
|
| Rate for Payer: TriValley Medical Group Senior |
$12,016.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,854.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,946.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,181.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2,799.43
|
|
