|
KETOROLAC 10 MG TABLET [10371]
|
Facility
|
OP
|
$2.17
|
|
|
Service Code
|
NDC 0378-1134-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.33
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Senior |
$0.87
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: Networks By Design Commercial |
$1.41
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Blue Shield of California EPN |
$2.19
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cigna of CA HMO |
$2.53
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$2.53
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.71
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.27
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$1.61
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.49
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cigna of CA HMO |
$2.53
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$2.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Galaxy Health WC |
$3.83
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$1.27
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$2.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Commercial |
$1.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]
|
Facility
|
IP
|
$7.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$3.32
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cigna of CA HMO |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$4.79
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$0.59
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.74
|
| Rate for Payer: EPIC Health Plan Senior |
$3.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.91
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]
|
Facility
|
OP
|
$7.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cigna of CA HMO |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA HMO |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$0.59
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$0.59
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Cigna of CA PPO |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$0.67
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Networks By Design Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
KETOROLAC 30 MG/ML INJECTION. [4082473]
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$4.79
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Networks By Design Commercial |
$3.42
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
KETOROLAC 30 MG/ML INJECTION. [4082473]
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.32
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA HMO |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: Cigna of CA PPO |
$4.79
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.91
|
| Rate for Payer: EPIC Health Plan Senior |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Galaxy Health WC |
$6.66
|
| Rate for Payer: Global Benefits Group Commercial |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$3.92
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Commercial |
$6.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.94
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
|
|
KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Senior |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
|
|
KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 72485-617-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$1.09
|
| Rate for Payer: Cigna of CA PPO |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
OP
|
$2.11
|
|
|
Service Code
|
NDC 76385-106-17
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.30
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Senior |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.37
|
| Rate for Payer: Prime Health Services Commercial |
$1.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.79
|
| Rate for Payer: Vantage Medical Group Senior |
$1.79
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 72485-617-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$1.09
|
| Rate for Payer: Cigna of CA PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
KETOTIFEN 0.025 % EYE DROPS [25471]
|
Facility
|
IP
|
$2.11
|
|
|
Service Code
|
NDC 76385-106-17
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Senior |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.37
|
| Rate for Payer: Prime Health Services Commercial |
$1.79
|
|
|
Kidney-Heart Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Heart Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Heart Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Heart Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Heart Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$282,500.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$282,500.00
|
|
|
Kidney-Liver Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: Blue Distinction Transplant |
$263,446.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
Kidney-Liver Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: Blue Distinction Transplant |
$263,446.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
Kidney-Liver Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 006
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: Blue Distinction Transplant |
$263,446.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
Kidney-Liver Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 005
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: Blue Distinction Transplant |
$263,446.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
Kidney-Liver Transplant
|
Facility
|
IP
|
$285,000.00
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$226,000.00 |
| Max. Negotiated Rate |
$285,000.00 |
| Rate for Payer: Blue Distinction Transplant |
$263,446.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$285,000.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$226,000.00
|
|
|
KIT FOR PREPARATION OF TC 99M-ALBUMIN 2.5 MG INTRAVENOUS SOLUTION [153474]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.11
|
| Rate for Payer: Blue Shield of California Commercial |
$22.03
|
| Rate for Payer: Blue Shield of California EPN |
$14.54
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
KIT FOR PREPARATION OF TC 99M-ALBUMIN 2.5 MG INTRAVENOUS SOLUTION [153474]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26.57
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.15
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
|
