|
RESLIZUMAB 10 MG/ML INTRAVENOUS SOLUTION [214073]
|
Facility
IP
|
$126.00
|
|
|
Service Code
|
NDC 59310-610-31
|
| Hospital Charge Code |
NDG214073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Blue Shield of California Commercial |
$89.71
|
| Rate for Payer: Blue Shield of California EPN |
$64.51
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
RESLIZUMAB 10 MG/ML INTRAVENOUS SOLUTION [214073]
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
NDC 59310-610-31
|
| Hospital Charge Code |
NDG214073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$69.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$69.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.07
|
| Rate for Payer: BCBS Transplant Transplant |
$75.60
|
| Rate for Payer: Blue Shield of California Commercial |
$92.86
|
| Rate for Payer: Blue Shield of California EPN |
$73.58
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.10
|
| Rate for Payer: Dignity Health Media |
$107.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.00
|
| Rate for Payer: United Healthcare All Other HMO |
$63.00
|
| Rate for Payer: United Healthcare HMO Rider |
$63.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.10
|
| Rate for Payer: Vantage Medical Group Senior |
$107.10
|
|
|
RESPIRATORY FAILURE
|
Facility
IP
|
$6,916.49
|
|
|
Service Code
|
APR-DRG 1331
|
| Min. Negotiated Rate |
$5,305.68 |
| Max. Negotiated Rate |
$6,916.49 |
| Rate for Payer: IEHP Medi-Cal |
$5,305.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,916.49
|
|
|
RESPIRATORY FAILURE
|
Facility
IP
|
$17,199.01
|
|
|
Service Code
|
APR-DRG 1333
|
| Min. Negotiated Rate |
$13,193.45 |
| Max. Negotiated Rate |
$17,199.01 |
| Rate for Payer: IEHP Medi-Cal |
$13,193.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,199.01
|
|
|
RESPIRATORY FAILURE
|
Facility
IP
|
$28,387.77
|
|
|
Service Code
|
APR-DRG 1334
|
| Min. Negotiated Rate |
$21,776.41 |
| Max. Negotiated Rate |
$28,387.77 |
| Rate for Payer: IEHP Medi-Cal |
$21,776.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,387.77
|
|
|
RESPIRATORY FAILURE
|
Facility
IP
|
$11,419.30
|
|
|
Service Code
|
APR-DRG 1332
|
| Min. Negotiated Rate |
$8,759.81 |
| Max. Negotiated Rate |
$11,419.30 |
| Rate for Payer: IEHP Medi-Cal |
$8,759.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,419.30
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
IP
|
$26,490.18
|
|
|
Service Code
|
APR-DRG 1364
|
| Min. Negotiated Rate |
$20,320.76 |
| Max. Negotiated Rate |
$26,490.18 |
| Rate for Payer: IEHP Medi-Cal |
$20,320.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,490.18
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
IP
|
$13,144.88
|
|
|
Service Code
|
APR-DRG 1362
|
| Min. Negotiated Rate |
$10,083.51 |
| Max. Negotiated Rate |
$13,144.88 |
| Rate for Payer: IEHP Medi-Cal |
$10,083.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,144.88
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
IP
|
$18,685.17
|
|
|
Service Code
|
APR-DRG 1363
|
| Min. Negotiated Rate |
$14,333.49 |
| Max. Negotiated Rate |
$18,685.17 |
| Rate for Payer: IEHP Medi-Cal |
$14,333.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,685.17
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
IP
|
$9,498.65
|
|
|
Service Code
|
APR-DRG 1361
|
| Min. Negotiated Rate |
$7,286.47 |
| Max. Negotiated Rate |
$9,498.65 |
| Rate for Payer: IEHP Medi-Cal |
$7,286.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,498.65
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
IP
|
$14,249.75
|
|
|
Service Code
|
APR-DRG 1443
|
| Min. Negotiated Rate |
$10,931.06 |
| Max. Negotiated Rate |
$14,249.75 |
| Rate for Payer: IEHP Medi-Cal |
$10,931.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,249.75
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
IP
|
$24,849.72
|
|
|
Service Code
|
APR-DRG 1444
|
| Min. Negotiated Rate |
$19,062.35 |
| Max. Negotiated Rate |
$24,849.72 |
| Rate for Payer: IEHP Medi-Cal |
$19,062.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,849.72
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
IP
|
$7,664.88
|
|
|
Service Code
|
APR-DRG 1441
|
| Min. Negotiated Rate |
$5,879.77 |
| Max. Negotiated Rate |
$7,664.88 |
| Rate for Payer: IEHP Medi-Cal |
$5,879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,664.88
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
IP
|
$10,087.44
|
|
|
Service Code
|
APR-DRG 1442
|
| Min. Negotiated Rate |
$7,738.13 |
| Max. Negotiated Rate |
$10,087.44 |
| Rate for Payer: IEHP Medi-Cal |
$7,738.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,087.44
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
IP
|
$79,818.11
|
|
|
Service Code
|
APR-DRG 1304
|
| Min. Negotiated Rate |
$61,228.89 |
| Max. Negotiated Rate |
$79,818.11 |
| Rate for Payer: IEHP Medi-Cal |
$61,228.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79,818.11
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
IP
|
$50,339.66
|
|
|
Service Code
|
APR-DRG 1302
|
| Min. Negotiated Rate |
$38,615.82 |
| Max. Negotiated Rate |
$50,339.66 |
| Rate for Payer: IEHP Medi-Cal |
$38,615.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50,339.66
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
IP
|
$61,620.65
|
|
|
Service Code
|
APR-DRG 1303
|
| Min. Negotiated Rate |
$47,269.52 |
| Max. Negotiated Rate |
$61,620.65 |
| Rate for Payer: IEHP Medi-Cal |
$47,269.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,620.65
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
IP
|
$50,329.02
|
|
|
Service Code
|
APR-DRG 1301
|
| Min. Negotiated Rate |
$38,607.66 |
| Max. Negotiated Rate |
$50,329.02 |
| Rate for Payer: IEHP Medi-Cal |
$38,607.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50,329.02
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
IP
|
$0.31
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1759630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
RESP ONLY: HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 30 ML [40810176]
|
Facility
OP
|
$0.31
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1759630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.19
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
Revision of prior hypospadias repair requiring extensive dissection and excision of previously constructed structures including re-release of chordee and reconstruction of urethra and penis by use of local skin as grafts and island flaps and skin brought in as flaps or grafts
|
Facility
OP
|
$10,602.62
|
|
|
Service Code
|
CPT 54352
|
| Min. Negotiated Rate |
$1,762.76 |
| Max. Negotiated Rate |
$10,602.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Media |
$6,465.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,602.62
|
| Rate for Payer: Heritage Provider Network Transplant |
$10,602.62
|
| Rate for Payer: IEHP Medi-Cal |
$10,473.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$10,473.32
|
| Rate for Payer: IEHP Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,762.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [38072]
|
Facility
OP
|
$87.48
|
|
|
Service Code
|
CPT J2791
|
| Hospital Charge Code |
1712616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$74.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.55
|
| Rate for Payer: BCBS Transplant Transplant |
$52.49
|
| Rate for Payer: BCBS Transplant Transplant |
$57.74
|
| Rate for Payer: Blue Shield of California Commercial |
$64.47
|
| Rate for Payer: Blue Shield of California Commercial |
$70.92
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$61.24
|
| Rate for Payer: Cigna of CA HMO |
$67.36
|
| Rate for Payer: Cigna of CA PPO |
$61.24
|
| Rate for Payer: Cigna of CA PPO |
$67.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.80
|
| Rate for Payer: Dignity Health Media |
$81.80
|
| Rate for Payer: Dignity Health Media |
$74.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.99
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Galaxy Health WC |
$74.36
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$65.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$69.98
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Networks By Design Commercial |
$43.74
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
| Rate for Payer: Prime Health Services Commercial |
$74.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.74
|
| Rate for Payer: United Healthcare All Other HMO |
$48.12
|
| Rate for Payer: United Healthcare All Other HMO |
$43.74
|
| Rate for Payer: United Healthcare HMO Rider |
$48.12
|
| Rate for Payer: United Healthcare HMO Rider |
$43.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.36
|
| Rate for Payer: Vantage Medical Group Senior |
$81.80
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [38072]
|
Facility
IP
|
$96.23
|
|
|
Service Code
|
CPT J2791
|
| Hospital Charge Code |
1712616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$81.80 |
| Rate for Payer: Blue Shield of California Commercial |
$68.52
|
| Rate for Payer: Blue Shield of California Commercial |
$62.29
|
| Rate for Payer: Blue Shield of California EPN |
$49.27
|
| Rate for Payer: Blue Shield of California EPN |
$44.79
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$61.24
|
| Rate for Payer: Cigna of CA HMO |
$67.36
|
| Rate for Payer: Cigna of CA PPO |
$67.36
|
| Rate for Payer: Cigna of CA PPO |
$61.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.99
|
| Rate for Payer: Galaxy Health WC |
$81.80
|
| Rate for Payer: Galaxy Health WC |
$74.36
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Global Benefits Group Commercial |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Multiplan Commercial |
$69.98
|
| Rate for Payer: Networks By Design Commercial |
$43.74
|
| Rate for Payer: Networks By Design Commercial |
$48.12
|
| Rate for Payer: Prime Health Services Commercial |
$74.36
|
| Rate for Payer: Prime Health Services Commercial |
$81.80
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 15,000 UNIT (3,000 MCG)/13 ML INJ. SOLN [70576]
|
Facility
IP
|
$501.41
|
|
|
Service Code
|
CPT J2792
|
| Hospital Charge Code |
NDG70576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$426.20 |
| Rate for Payer: Blue Shield of California Commercial |
$357.00
|
| Rate for Payer: Blue Shield of California EPN |
$256.72
|
| Rate for Payer: Cash Price |
$225.63
|
| Rate for Payer: Cigna of CA HMO |
$350.99
|
| Rate for Payer: Cigna of CA PPO |
$350.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$200.56
|
| Rate for Payer: Galaxy Health WC |
$426.20
|
| Rate for Payer: Global Benefits Group Commercial |
$300.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.34
|
| Rate for Payer: Multiplan Commercial |
$401.13
|
| Rate for Payer: Networks By Design Commercial |
$250.70
|
| Rate for Payer: Prime Health Services Commercial |
$426.20
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 15,000 UNIT (3,000 MCG)/13 ML INJ. SOLN [70576]
|
Facility
OP
|
$501.41
|
|
|
Service Code
|
CPT J2792
|
| Hospital Charge Code |
NDG70576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$426.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$207.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.83
|
| Rate for Payer: BCBS Transplant Transplant |
$300.85
|
| Rate for Payer: Blue Shield of California Commercial |
$369.54
|
| Rate for Payer: Blue Shield of California EPN |
$41.17
|
| Rate for Payer: Cash Price |
$225.63
|
| Rate for Payer: Cash Price |
$225.63
|
| Rate for Payer: Cigna of CA HMO |
$350.99
|
| Rate for Payer: Cigna of CA PPO |
$350.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.45
|
| Rate for Payer: Dignity Health Media |
$32.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.96
|
| Rate for Payer: Galaxy Health WC |
$426.20
|
| Rate for Payer: Global Benefits Group Commercial |
$300.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$376.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.06
|
| Rate for Payer: Heritage Provider Network Transplant |
$54.06
|
| Rate for Payer: IEHP Medi-Cal |
$53.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$53.40
|
| Rate for Payer: IEHP Medicare Advantage |
$32.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.17
|
| Rate for Payer: Multiplan Commercial |
$401.13
|
| Rate for Payer: Networks By Design Commercial |
$250.70
|
| Rate for Payer: Prime Health Services Commercial |
$426.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.70
|
| Rate for Payer: United Healthcare All Other HMO |
$250.70
|
| Rate for Payer: United Healthcare HMO Rider |
$250.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.26
|
| Rate for Payer: Vantage Medical Group Senior |
$32.96
|
|
