|
DIGESTIVE MALIGNANCY
|
Facility
IP
|
$9,945.98
|
|
|
Service Code
|
APR-DRG 2403
|
| Min. Negotiated Rate |
$9,945.98 |
| Max. Negotiated Rate |
$9,945.98 |
| Rate for Payer: IEHP Medi-Cal |
$9,945.98
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
IP
|
$7,293.59
|
|
|
Service Code
|
APR-DRG 2402
|
| Min. Negotiated Rate |
$7,293.59 |
| Max. Negotiated Rate |
$7,293.59 |
| Rate for Payer: IEHP Medi-Cal |
$7,293.59
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
IP
|
$16,349.13
|
|
|
Service Code
|
APR-DRG 2404
|
| Min. Negotiated Rate |
$16,349.13 |
| Max. Negotiated Rate |
$16,349.13 |
| Rate for Payer: IEHP Medi-Cal |
$16,349.13
|
|
|
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION [9853]
|
Facility
IP
|
$151.63
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$113.72 |
| Rate for Payer: Adventist Health Commercial |
$30.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.17
|
| Rate for Payer: Cash Price |
$68.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.65
|
| Rate for Payer: Heritage Provider Network Senior |
$102.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.91
|
| Rate for Payer: Multiplan Commercial |
$113.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$50.66
|
|
|
DIGOXIN 100 MCG/ML (0.1 MG/ML) INJECTION SOLUTION [9853]
|
Facility
OP
|
$151.63
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$128.89 |
| Rate for Payer: Adventist Health Commercial |
$30.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$128.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$83.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Cash Price |
$68.23
|
| Rate for Payer: Cash Price |
$68.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.89
|
| Rate for Payer: Dignity Health Senior |
$128.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.20
|
| Rate for Payer: Heritage Provider Network Senior |
$70.20
|
| Rate for Payer: IEHP Medi-Cal |
$21.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.91
|
| Rate for Payer: Multiplan Commercial |
$113.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$50.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.89
|
| Rate for Payer: Vantage Medical Group Senior |
$128.89
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
OP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-11
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.48
|
| Rate for Payer: Dignity Health Senior |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
OP
|
$1.42
|
|
|
Service Code
|
NDC 0143-1240-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.21
|
| Rate for Payer: Dignity Health Senior |
$1.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.88
|
| Rate for Payer: Heritage Provider Network Senior |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: Vantage Medical Group Senior |
$1.21
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-11
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.20
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
OP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.48
|
| Rate for Payer: Dignity Health Senior |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
OP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5921-61
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: Dignity Health Senior |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.42
|
|
|
Service Code
|
NDC 0143-1240-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.98
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Senior |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
NDC 68084-366-01
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.20
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
IP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5921-61
|
| Hospital Charge Code |
1710290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.11
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
OP
|
$1.39
|
|
|
Service Code
|
NDC 60687-551-11
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.18
|
| Rate for Payer: Dignity Health Senior |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.86
|
| Rate for Payer: Heritage Provider Network Senior |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1.18
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
OP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5922-61
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.38
|
| Rate for Payer: Dignity Health Senior |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
IP
|
$1.62
|
|
|
Service Code
|
NDC 0904-5922-61
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.11
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET [2445]
|
Facility
IP
|
$1.39
|
|
|
Service Code
|
NDC 60687-551-11
|
| Hospital Charge Code |
1710304
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Senior |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.04
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [110919]
|
Facility
IP
|
$3.30
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$15.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.27
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.23
|
| Rate for Payer: Heritage Provider Network Senior |
$51.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$56.86
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.33
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION [110919]
|
Facility
OP
|
$3.30
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
1720137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Commercial |
$15.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$56.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Cash Price |
$34.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.45
|
| Rate for Payer: Dignity Health Senior |
$64.45
|
| Rate for Payer: Dignity Health Senior |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.53
|
| Rate for Payer: Heritage Provider Network Senior |
$35.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.53
|
| Rate for Payer: IEHP Medi-Cal |
$21.64
|
| Rate for Payer: IEHP Medi-Cal |
$21.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$56.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2.80
|
| Rate for Payer: Vantage Medical Group Senior |
$64.45
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]
|
Facility
OP
|
$2.80
|
|
|
Service Code
|
NDC 0054-0057-46
|
| Hospital Charge Code |
1715678
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.38
|
| Rate for Payer: Dignity Health Senior |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2.38
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION [43556]
|
Facility
IP
|
$2.80
|
|
|
Service Code
|
NDC 0054-0057-46
|
| Hospital Charge Code |
1715678
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.92
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]
|
Facility
IP
|
$5,518.80
|
|
|
Service Code
|
CPT J1162
|
| Hospital Charge Code |
1712460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$998.90 |
| Max. Negotiated Rate |
$4,139.10 |
| Rate for Payer: Adventist Health Commercial |
$1,103.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,791.42
|
| Rate for Payer: Cash Price |
$2,483.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,538.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,980.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.23
|
| Rate for Payer: Heritage Provider Network Senior |
$3,736.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$998.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,379.70
|
| Rate for Payer: Multiplan Commercial |
$4,139.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,012.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,843.83
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION [31432]
|
Facility
OP
|
$5,518.80
|
|
|
Service Code
|
CPT J1162
|
| Hospital Charge Code |
1712460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$998.90 |
| Max. Negotiated Rate |
$11,736.38 |
| Rate for Payer: Adventist Health Commercial |
$1,103.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,736.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,791.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,971.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,255.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,255.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,350.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,510.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,510.44
|
| Rate for Payer: Cash Price |
$2,483.46
|
| Rate for Payer: Cash Price |
$2,483.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,538.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,166.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,255.19
|
| Rate for Payer: Dignity Health Senior |
$5,255.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,532.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,777.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,555.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,555.20
|
| Rate for Payer: Humana Medicare |
$4,777.44
|
| Rate for Payer: IEHP Medi-Cal |
$7,459.76
|
| Rate for Payer: IEHP Medicare Advantage |
$4,777.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,077.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$998.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,637.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,379.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,019.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,019.58
|
| Rate for Payer: Multiplan Commercial |
$4,139.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,255.19
|
| Rate for Payer: TriValley Medical Group Senior |
$4,777.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,012.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,843.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,166.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,255.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,777.44
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]
|
Facility
OP
|
$101.05
|
|
|
Service Code
|
CPT J1110
|
| Hospital Charge Code |
1720065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$104.01 |
| Rate for Payer: Adventist Health Commercial |
$20.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$75.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.28
|
| Rate for Payer: Blue Shield of California Commercial |
$85.89
|
| Rate for Payer: Blue Shield of California EPN |
$85.89
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.89
|
| Rate for Payer: Dignity Health Senior |
$85.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.79
|
| Rate for Payer: Heritage Provider Network Senior |
$46.79
|
| Rate for Payer: IEHP Medi-Cal |
$73.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$75.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.89
|
| Rate for Payer: Vantage Medical Group Senior |
$85.89
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION [9859]
|
Facility
IP
|
$101.05
|
|
|
Service Code
|
CPT J1110
|
| Hospital Charge Code |
1720065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Adventist Health Commercial |
$20.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.42
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.41
|
| Rate for Payer: Heritage Provider Network Senior |
$68.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$75.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.76
|
|
