|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
IP
|
$1.42
|
|
|
Service Code
|
NDC 50268-260-11
|
| Hospital Charge Code |
1711851
|
|
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
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
OP
|
$1.42
|
|
|
Service Code
|
NDC 50268-260-11
|
| Hospital Charge Code |
1711851
|
|
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
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
IP
|
$0.29
|
|
|
Service Code
|
NDC 65862-595-01
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
OP
|
$2.63
|
|
|
Service Code
|
NDC 68084-415-11
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.24
|
| Rate for Payer: Dignity Health Senior |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: Vantage Medical Group Senior |
$2.24
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
IP
|
$2.63
|
|
|
Service Code
|
NDC 68084-415-01
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.81
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
OP
|
$2.63
|
|
|
Service Code
|
NDC 68084-415-01
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.24
|
| Rate for Payer: Dignity Health Senior |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: Vantage Medical Group Senior |
$2.24
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
IP
|
$2.98
|
|
|
Service Code
|
NDC 51079-767-08
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Senior |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
IP
|
$2.63
|
|
|
Service Code
|
NDC 68084-415-11
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.81
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
OP
|
$0.29
|
|
|
Service Code
|
NDC 65862-595-01
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Senior |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
OP
|
$0.86
|
|
|
Service Code
|
NDC 55111-534-01
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.73
|
| Rate for Payer: Dignity Health Senior |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.73
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
IP
|
$0.86
|
|
|
Service Code
|
NDC 55111-534-01
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.59
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
OP
|
$2.98
|
|
|
Service Code
|
NDC 51079-767-08
|
| Hospital Charge Code |
1711851
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.53
|
| Rate for Payer: Dignity Health Senior |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.53
|
| Rate for Payer: Vantage Medical Group Senior |
$2.53
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
IP
|
$6,021.11
|
|
|
Service Code
|
APR-DRG 2442
|
| Min. Negotiated Rate |
$6,021.11 |
| Max. Negotiated Rate |
$6,021.11 |
| Rate for Payer: IEHP Medi-Cal |
$6,021.11
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
IP
|
$15,583.06
|
|
|
Service Code
|
APR-DRG 2444
|
| Min. Negotiated Rate |
$15,583.06 |
| Max. Negotiated Rate |
$15,583.06 |
| Rate for Payer: IEHP Medi-Cal |
$15,583.06
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
IP
|
$9,104.29
|
|
|
Service Code
|
APR-DRG 2443
|
| Min. Negotiated Rate |
$9,104.29 |
| Max. Negotiated Rate |
$9,104.29 |
| Rate for Payer: IEHP Medi-Cal |
$9,104.29
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
IP
|
$4,608.36
|
|
|
Service Code
|
APR-DRG 2441
|
| Min. Negotiated Rate |
$4,608.36 |
| Max. Negotiated Rate |
$4,608.36 |
| Rate for Payer: IEHP Medi-Cal |
$4,608.36
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]
|
Facility
OP
|
$0.42
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1757187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$24.20 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: IEHP Medi-Cal |
$22.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]
|
Facility
IP
|
$0.42
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1757187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS [15981]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1759122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| 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: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS [15981]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1759122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$24.20 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: IEHP Medi-Cal |
$22.32
|
| Rate for Payer: IEHP Medi-Cal |
$22.32
|
| Rate for Payer: IEHP Medi-Cal |
$22.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV [18315]
|
Facility
OP
|
$0.19
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1759123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$24.20 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Senior |
$0.16
|
| Rate for Payer: Dignity Health Senior |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: IEHP Medi-Cal |
$22.32
|
| Rate for Payer: IEHP Medi-Cal |
$22.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV [18315]
|
Facility
IP
|
$0.07
|
|
|
Service Code
|
CPT J1250
|
| Hospital Charge Code |
1759123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
|
|
DOCETAXEL 160 MG/16 ML (10 MG/ML) INTRAVENOUS SOLUTION [108908]
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$41.42 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.63
|
| Rate for Payer: Dignity Health Senior |
$17.41
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$36.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.95
|
| Rate for Payer: Heritage Provider Network Senior |
$9.48
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$19.95
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: IEHP Medi-Cal |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: Multiplan Commercial |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: Vantage Medical Group Senior |
$17.41
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$36.63
|
|
|
DOCETAXEL 160 MG/16 ML (10 MG/ML) INTRAVENOUS SOLUTION [108908]
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG108908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.86
|
| Rate for Payer: Heritage Provider Network Senior |
$13.86
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$29.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$32.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.40
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [196796]
|
Facility
IP
|
$25.50
|
|
|
Service Code
|
CPT J9171
|
| Hospital Charge Code |
NDG196796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.52
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.26
|
| Rate for Payer: Heritage Provider Network Senior |
$17.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.52
|
|
