|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0116-1061-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| 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 |
$0.03
|
|
|
CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID [28188]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0116-1061-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| 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 |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| 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 |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CHLORHEXIDINE (PERIDEX) 0.12% ALCHOHOL-FREE ORAL SYRINGE [4081169]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 52376-021-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
CHLORHEXIDINE (PERIDEX) 0.12% ALCHOHOL-FREE ORAL SYRINGE [4081169]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 52376-021-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Senior |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
CHLOROPROCAINE 20 MG/ML (2 %) INJECTION SOLUTION [110537]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.63
|
| Rate for Payer: Dignity Health Senior |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Senior |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
CHLOROPROCAINE 20 MG/ML (2 %) INJECTION SOLUTION [110537]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Senior |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.25
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [1635]
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.14
|
| Rate for Payer: Dignity Health Senior |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Vantage Medical Group Senior |
$1.14
|
|
|
CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION [1635]
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
HCPCS J2401
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
|
|
CHLOROQUINE ORAL SUSPENSION COMPOUND 15 MG/ML [4080254]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 9994-0802-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
CHLOROQUINE ORAL SUSPENSION COMPOUND 15 MG/ML [4080254]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 9994-0802-54
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION [9525]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 65649-311-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSPENSION [9525]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 65649-311-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.30 |
| 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 |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Senior |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| 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 |
$0.06
|
| 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 |
$0.26
|
| 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 |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Adventist Health Commercial |
$23.95
|
| Rate for Payer: Adventist Health Commercial |
$6.70
|
| Rate for Payer: Adventist Health Commercial |
$71.45
|
| Rate for Payer: Cash Price |
$65.87
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$18.43
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.45
|
| Rate for Payer: Heritage Provider Network Senior |
$15.52
|
| Rate for Payer: Heritage Provider Network Senior |
$55.45
|
| Rate for Payer: Heritage Provider Network Senior |
$88.90
|
| Rate for Payer: Heritage Provider Network Senior |
$165.40
|
| Rate for Payer: Heritage Provider Network Senior |
$33.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$25.14
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$267.93
|
| Rate for Payer: Multiplan Commercial |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.84
|
|
|
CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION [9526]
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS J1205
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$212.33 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$23.95
|
| Rate for Payer: Adventist Health Commercial |
$6.70
|
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Adventist Health Commercial |
$71.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$190.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$303.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.33
|
| Rate for Payer: Blue Shield of California Commercial |
$83.62
|
| Rate for Payer: Blue Shield of California Commercial |
$83.62
|
| Rate for Payer: Blue Shield of California Commercial |
$83.62
|
| Rate for Payer: Blue Shield of California Commercial |
$83.62
|
| Rate for Payer: Blue Shield of California Commercial |
$83.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.62
|
| Rate for Payer: Cash Price |
$65.87
|
| Rate for Payer: Cash Price |
$65.87
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Cash Price |
$18.43
|
| Rate for Payer: Cash Price |
$18.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$303.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$303.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Senior |
$61.20
|
| Rate for Payer: Dignity Health Senior |
$303.65
|
| Rate for Payer: Dignity Health Senior |
$163.20
|
| Rate for Payer: Dignity Health Senior |
$28.49
|
| Rate for Payer: Dignity Health Senior |
$101.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.40
|
| Rate for Payer: Heritage Provider Network Senior |
$88.90
|
| Rate for Payer: Heritage Provider Network Senior |
$165.40
|
| Rate for Payer: Heritage Provider Network Senior |
$55.45
|
| Rate for Payer: Heritage Provider Network Senior |
$15.52
|
| Rate for Payer: Heritage Provider Network Senior |
$33.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$91.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.07
|
| Rate for Payer: Multiplan Commercial |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$25.14
|
| Rate for Payer: Multiplan Commercial |
$267.93
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$142.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Senior |
$76.80
|
| Rate for Payer: TriValley Medical Group Senior |
$28.80
|
| Rate for Payer: TriValley Medical Group Senior |
$142.90
|
| Rate for Payer: TriValley Medical Group Senior |
$13.41
|
| Rate for Payer: TriValley Medical Group Senior |
$47.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$303.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$303.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$101.80
|
| Rate for Payer: Vantage Medical Group Senior |
$303.65
|
| Rate for Payer: Vantage Medical Group Senior |
$28.49
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 68462-861-01
|
| 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: Cash Price |
$0.39
|
| 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 Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 69238-1054-1
|
| 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: Cash Price |
$0.39
|
| 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 Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 69238-1054-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| 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: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.39
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| 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
|
|
|
CHLORPROMAZINE 10 MG TABLET [1653]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 68462-861-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| 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: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.39
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| 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
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION [1649]
|
Facility
|
OP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$88.04 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.04
|
| Rate for Payer: Blue Shield of California Commercial |
$42.34
|
| Rate for Payer: Blue Shield of California EPN |
$42.34
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.88
|
| Rate for Payer: Dignity Health Senior |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.20
|
| Rate for Payer: Heritage Provider Network Senior |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.90
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.94
|
| Rate for Payer: TriValley Medical Group Senior |
$7.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.88
|
| Rate for Payer: Vantage Medical Group Senior |
$16.88
|
|
|
CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION [1649]
|
Facility
|
IP
|
$19.86
|
|
|
Service Code
|
HCPCS J3230
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.20
|
| Rate for Payer: Heritage Provider Network Senior |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.58
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 68462-862-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Senior |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
|
OP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Adventist Health Commercial |
$1.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.33
|
| Rate for Payer: Blue Shield of California Commercial |
$4.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.47
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.04
|
| Rate for Payer: Dignity Health Senior |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.40
|
| Rate for Payer: Heritage Provider Network Senior |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.98
|
| Rate for Payer: Multiplan Commercial |
$5.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.84
|
| Rate for Payer: TriValley Medical Group Senior |
$2.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.04
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 68462-862-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.87
|
| Rate for Payer: Dignity Health Senior |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.63
|
| Rate for Payer: Heritage Provider Network Senior |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Senior |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Vantage Medical Group Senior |
$0.87
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 69238-1056-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Senior |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
|
|
CHLORPROMAZINE 25 MG TABLET [1656]
|
Facility
|
IP
|
$7.11
|
|
|
Service Code
|
NDC 60687-430-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.33 |
| Rate for Payer: Adventist Health Commercial |
$1.42
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.81
|
| Rate for Payer: Heritage Provider Network Senior |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$5.33
|
|
